|
HC SKIN SUB GRFT DIGIT 1ST 25 SQ
|
Facility
OP
|
$5,287.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
900501784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,057.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,632.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$2,379.15
|
| Rate for Payer: Cash Price |
$2,379.15
|
| Rate for Payer: Cash Price |
$2,379.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,436.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: Dignity Health Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,579.30
|
| Rate for Payer: Heritage Provider Network Senior |
$3,579.30
|
| Rate for Payer: Humana Medicare |
$2,278.49
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,548.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$956.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,688.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,321.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,870.90
|
| Rate for Payer: Multiplan Commercial |
$3,965.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,919.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,766.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC SKIN SUB GRFT DIGIT 1ST 25 SQ
|
Facility
IP
|
$5,287.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
900501784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$956.95 |
| Max. Negotiated Rate |
$3,965.25 |
| Rate for Payer: Adventist Health Commercial |
$1,057.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,632.17
|
| Rate for Payer: Cash Price |
$2,379.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,579.30
|
| Rate for Payer: Heritage Provider Network Senior |
$3,579.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$956.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,321.75
|
| Rate for Payer: Multiplan Commercial |
$3,965.25
|
|
|
HC SKIN SUB GRFT DIGIT 1ST 25 SQ
|
Facility
IP
|
$5,287.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
900501784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$956.95 |
| Max. Negotiated Rate |
$3,965.25 |
| Rate for Payer: Adventist Health Commercial |
$1,057.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,632.17
|
| Rate for Payer: Cash Price |
$2,379.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,579.30
|
| Rate for Payer: Heritage Provider Network Senior |
$3,579.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$956.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,321.75
|
| Rate for Payer: Multiplan Commercial |
$3,965.25
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET 1ST 100 SQ CM
|
Facility
OP
|
$4,626.00
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
900101503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$925.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,178.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,872.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,715.46
|
| Rate for Payer: Cash Price |
$2,081.70
|
| Rate for Payer: Cash Price |
$2,081.70
|
| Rate for Payer: Cash Price |
$2,081.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,006.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: Dignity Health Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,863.49
|
| Rate for Payer: Heritage Provider Network Senior |
$2,863.49
|
| Rate for Payer: Humana Medicare |
$2,278.49
|
| Rate for Payer: IEHP Medi-Cal |
$276.35
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,329.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$837.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,688.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,156.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,870.90
|
| Rate for Payer: Multiplan Commercial |
$3,469.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,506.34
|
| Rate for Payer: TriValley Medical Group Senior |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET 1ST 100 SQ CM
|
Facility
IP
|
$4,626.00
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
900101503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$837.31 |
| Max. Negotiated Rate |
$3,469.50 |
| Rate for Payer: Adventist Health Commercial |
$925.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,178.06
|
| Rate for Payer: Cash Price |
$2,081.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,131.80
|
| Rate for Payer: Heritage Provider Network Senior |
$3,131.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$837.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,156.50
|
| Rate for Payer: Multiplan Commercial |
$3,469.50
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET ADDL 100 SQ CM
|
Facility
IP
|
$2,313.00
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
900101504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$418.65 |
| Max. Negotiated Rate |
$1,734.75 |
| Rate for Payer: Adventist Health Commercial |
$462.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,589.03
|
| Rate for Payer: Cash Price |
$1,040.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,565.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,565.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$418.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.25
|
| Rate for Payer: Multiplan Commercial |
$1,734.75
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET ADDL 100 SQ CM
|
Facility
OP
|
$2,313.00
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
900101504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.86 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$462.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,589.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,966.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,272.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,734.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,436.37
|
| Rate for Payer: Blue Shield of California EPN |
$1,357.73
|
| Rate for Payer: Cash Price |
$1,040.85
|
| Rate for Payer: Cash Price |
$1,040.85
|
| Rate for Payer: Cash Price |
$1,040.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,503.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,966.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,966.05
|
| Rate for Payer: Dignity Health Senior |
$1,966.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,431.75
|
| Rate for Payer: Heritage Provider Network Senior |
$1,431.75
|
| Rate for Payer: IEHP Medi-Cal |
$70.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,114.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$418.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.25
|
| Rate for Payer: Multiplan Commercial |
$1,734.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,156.50
|
| Rate for Payer: TriValley Medical Group Senior |
$1,156.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,966.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,966.05
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET ADDL 25 SQ CM
|
Facility
OP
|
$2,313.00
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
900101502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.76 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$462.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,589.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,966.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,272.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,734.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,436.37
|
| Rate for Payer: Blue Shield of California EPN |
$1,357.73
|
| Rate for Payer: Cash Price |
$1,040.85
|
| Rate for Payer: Cash Price |
$1,040.85
|
| Rate for Payer: Cash Price |
$1,040.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,503.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,966.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,966.05
|
| Rate for Payer: Dignity Health Senior |
$1,966.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,431.75
|
| Rate for Payer: Heritage Provider Network Senior |
$1,431.75
|
| Rate for Payer: IEHP Medi-Cal |
$31.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,114.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$418.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.25
|
| Rate for Payer: Multiplan Commercial |
$1,734.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,156.50
|
| Rate for Payer: TriValley Medical Group Senior |
$1,156.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,966.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,966.05
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET ADDL 25 SQ CM
|
Facility
IP
|
$2,313.00
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
900101502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$418.65 |
| Max. Negotiated Rate |
$1,734.75 |
| Rate for Payer: Adventist Health Commercial |
$462.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,589.03
|
| Rate for Payer: Cash Price |
$1,040.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,565.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,565.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$418.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.25
|
| Rate for Payer: Multiplan Commercial |
$1,734.75
|
|
|
HC SKIN SUBSTITUTE PRIMATRIX 3X3
|
Facility
IP
|
$263.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$197.25 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$180.68
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$178.05
|
| Rate for Payer: Heritage Provider Network Senior |
$178.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.75
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$87.87
|
|
|
HC SKIN SUBSTITUTE PRIMATRIX 3X3
|
Facility
OP
|
$263.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$223.55 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$95.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$180.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$223.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$144.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$197.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.80
|
| Rate for Payer: Blue Shield of California Commercial |
$163.32
|
| Rate for Payer: Blue Shield of California EPN |
$154.38
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$223.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$223.55
|
| Rate for Payer: Dignity Health Senior |
$223.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.77
|
| Rate for Payer: Heritage Provider Network Senior |
$121.77
|
| Rate for Payer: IEHP Medi-Cal |
$66.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$126.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.75
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$87.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$223.55
|
| Rate for Payer: Vantage Medical Group Senior |
$223.55
|
|
|
HC SKULL COMPLETE
|
Facility
IP
|
$633.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
909001143
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.57 |
| Max. Negotiated Rate |
$474.75 |
| Rate for Payer: Adventist Health Commercial |
$126.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$434.87
|
| Rate for Payer: Cash Price |
$284.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$428.54
|
| Rate for Payer: Heritage Provider Network Senior |
$428.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.25
|
| Rate for Payer: Multiplan Commercial |
$474.75
|
|
|
HC SKULL COMPLETE
|
Facility
OP
|
$633.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
909001143
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.74 |
| Max. Negotiated Rate |
$474.75 |
| Rate for Payer: Adventist Health Commercial |
$126.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$68.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$434.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$215.09
|
| Rate for Payer: Blue Shield of California Commercial |
$182.95
|
| Rate for Payer: Blue Shield of California EPN |
$104.04
|
| Rate for Payer: Cash Price |
$284.85
|
| Rate for Payer: Cash Price |
$284.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$411.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$391.83
|
| Rate for Payer: Heritage Provider Network Senior |
$391.83
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$62.74
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$474.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC SKULL LIMITED
|
Facility
OP
|
$1,057.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
909001144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.53 |
| Max. Negotiated Rate |
$792.75 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$726.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.88
|
| Rate for Payer: Blue Shield of California Commercial |
$127.22
|
| Rate for Payer: Blue Shield of California EPN |
$72.34
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$687.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$654.28
|
| Rate for Payer: Heritage Provider Network Senior |
$654.28
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$40.53
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC SKULL LIMITED
|
Facility
IP
|
$1,057.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
909001144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.32 |
| Max. Negotiated Rate |
$792.75 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$726.16
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$715.59
|
| Rate for Payer: Heritage Provider Network Senior |
$715.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.25
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
|
|
HC SLING ARM PED PRINT CHILD
|
Facility
IP
|
$14.82
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698366
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$2.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.03
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Multiplan Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.95
|
|
|
HC SLING ARM PED PRINT CHILD
|
Facility
OP
|
$14.82
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698366
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$2.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.20
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.60
|
| Rate for Payer: Dignity Health Senior |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.86
|
| Rate for Payer: Heritage Provider Network Senior |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Multiplan Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.60
|
| Rate for Payer: Vantage Medical Group Senior |
$12.60
|
|
|
HC SLITTING OF PREPUCE
|
Facility
IP
|
$4,499.00
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
900501305
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$814.32 |
| Max. Negotiated Rate |
$3,374.25 |
| Rate for Payer: Adventist Health Commercial |
$899.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,090.81
|
| Rate for Payer: Cash Price |
$2,024.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,045.82
|
| Rate for Payer: Heritage Provider Network Senior |
$3,045.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$814.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,124.75
|
| Rate for Payer: Multiplan Commercial |
$3,374.25
|
|
|
HC SLITTING OF PREPUCE
|
Facility
OP
|
$4,499.00
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
900501305
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$814.32 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$899.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,090.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$2,024.55
|
| Rate for Payer: Cash Price |
$2,024.55
|
| Rate for Payer: Cash Price |
$2,024.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,924.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: Dignity Health Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,544.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,045.82
|
| Rate for Payer: Heritage Provider Network Senior |
$3,045.82
|
| Rate for Payer: Humana Medicare |
$2,544.87
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,168.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$814.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,002.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,124.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,206.54
|
| Rate for Payer: Multiplan Commercial |
$3,374.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,633.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,503.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC SLOW ACTIVATION
|
Facility
IP
|
$171.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910078
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.95 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$117.48
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.77
|
| Rate for Payer: Heritage Provider Network Senior |
$115.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
|
|
HC SLOW ACTIVATION
|
Facility
OP
|
$22.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910078
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$50.27 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.27
|
| Rate for Payer: Blue Shield of California Commercial |
$46.84
|
| Rate for Payer: Blue Shield of California EPN |
$36.62
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: Dignity Health Senior |
$6.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Humana Medicare |
$6.01
|
| Rate for Payer: IEHP Medi-Cal |
$8.33
|
| Rate for Payer: IEHP Medicare Advantage |
$6.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.57
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.01
|
| Rate for Payer: TriValley Medical Group Senior |
$6.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
|
|
HC SM153 LEXIDRONAMM 50 MCI QUADR
|
Facility
OP
|
$26,273.00
|
|
|
Service Code
|
CPT A9604
|
| Hospital Charge Code |
909301571
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$4,755.41 |
| Max. Negotiated Rate |
$39,446.43 |
| Rate for Payer: Adventist Health Commercial |
$5,254.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39,446.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,049.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25,889.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18,985.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17,259.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,023.80
|
| Rate for Payer: Blue Shield of California Commercial |
$16,315.53
|
| Rate for Payer: Blue Shield of California EPN |
$15,422.25
|
| Rate for Payer: Cash Price |
$11,822.85
|
| Rate for Payer: Cash Price |
$11,822.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,077.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,889.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,985.84
|
| Rate for Payer: Dignity Health Senior |
$17,259.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,814.72
|
| Rate for Payer: EPIC Health Plan Medicare |
$17,259.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,262.99
|
| Rate for Payer: Heritage Provider Network Senior |
$16,262.99
|
| Rate for Payer: Humana Medicare |
$17,259.85
|
| Rate for Payer: IEHP Medi-Cal |
$25,408.25
|
| Rate for Payer: IEHP Medicare Advantage |
$17,259.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32,793.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,755.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,366.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,568.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,747.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21,747.41
|
| Rate for Payer: Multiplan Commercial |
$19,704.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$18,985.84
|
| Rate for Payer: TriValley Medical Group Senior |
$17,259.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,579.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,777.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25,889.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,985.84
|
| Rate for Payer: Vantage Medical Group Senior |
$17,259.85
|
|
|
HC SM153 LEXIDRONAMM 50 MCI QUADR
|
Facility
IP
|
$26,273.00
|
|
|
Service Code
|
CPT A9604
|
| Hospital Charge Code |
909301571
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$4,755.41 |
| Max. Negotiated Rate |
$19,704.75 |
| Rate for Payer: Adventist Health Commercial |
$5,254.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,049.55
|
| Rate for Payer: Cash Price |
$11,822.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,187.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,786.82
|
| Rate for Payer: Heritage Provider Network Senior |
$17,786.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,755.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,568.25
|
| Rate for Payer: Multiplan Commercial |
$19,704.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,579.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,777.81
|
|
|
HC SMALL BOWEL SNGL CNTRST
|
Facility
OP
|
$1,191.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
909001828
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.33 |
| Max. Negotiated Rate |
$893.25 |
| Rate for Payer: Adventist Health Commercial |
$238.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$185.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$818.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$312.07
|
| Rate for Payer: Blue Shield of California Commercial |
$266.69
|
| Rate for Payer: Blue Shield of California EPN |
$151.66
|
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$774.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: Dignity Health Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$774.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$737.23
|
| Rate for Payer: Heritage Provider Network Senior |
$737.23
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: IEHP Medi-Cal |
$147.61
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$893.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$229.56
|
| Rate for Payer: TriValley Medical Group Senior |
$229.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC SMALL BOWEL SNGL CNTRST
|
Facility
IP
|
$1,191.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
909001828
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$215.57 |
| Max. Negotiated Rate |
$893.25 |
| Rate for Payer: Adventist Health Commercial |
$238.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$818.22
|
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$806.31
|
| Rate for Payer: Heritage Provider Network Senior |
$806.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.75
|
| Rate for Payer: Multiplan Commercial |
$893.25
|
|
