|
HC BIOPSY OF CERVIX
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
900501433
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$318.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,092.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,659.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,217.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,106.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,033.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,659.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,217.00
|
| Rate for Payer: Dignity Health Senior |
$1,106.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,106.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,076.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,076.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,106.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$758.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,272.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,394.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,394.01
|
| Rate for Payer: Multiplan Commercial |
$1,192.50
|
| Rate for Payer: Multiplan WC |
$1,762.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$572.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,659.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,217.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,106.36
|
|
|
HC BIOPSY OF CERVIX
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
900501433
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$287.79 |
| Max. Negotiated Rate |
$1,192.50 |
| Rate for Payer: Adventist Health Commercial |
$318.00
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,076.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,076.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.50
|
| Rate for Payer: Multiplan Commercial |
$1,192.50
|
|
|
HC BIOPSY OF HIP JOINT
|
Facility
|
IP
|
$10,416.00
|
|
|
Service Code
|
CPT 27052
|
| Hospital Charge Code |
909020043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,885.30 |
| Max. Negotiated Rate |
$7,812.00 |
| Rate for Payer: Adventist Health Commercial |
$2,083.20
|
| Rate for Payer: Cash Price |
$5,728.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,051.63
|
| Rate for Payer: Heritage Provider Network Senior |
$7,051.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,885.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,604.00
|
| Rate for Payer: Multiplan Commercial |
$7,812.00
|
|
|
HC BIOPSY OF HIP JOINT
|
Facility
|
OP
|
$10,416.00
|
|
|
Service Code
|
CPT 27052
|
| Hospital Charge Code |
909020043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,083.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,155.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| 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 |
$5,728.80
|
| Rate for Payer: Cash Price |
$5,728.80
|
| Rate for Payer: Cash Price |
$5,728.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,770.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Senior |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,033.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,447.50
|
| Rate for Payer: Heritage Provider Network Senior |
$2,501.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$168.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,863.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,885.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,338.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,604.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,562.18
|
| Rate for Payer: Multiplan Commercial |
$7,812.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,236.83
|
| Rate for Payer: TriValley Medical Group Senior |
$2,236.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC BIOPSY OF SOFT TISSUE PELVIS/HIP
|
Facility
|
IP
|
$2,462.00
|
|
|
Service Code
|
CPT 27040
|
| Hospital Charge Code |
904000006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$445.62 |
| Max. Negotiated Rate |
$1,846.50 |
| Rate for Payer: Adventist Health Commercial |
$492.40
|
| Rate for Payer: Cash Price |
$1,354.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,666.77
|
| Rate for Payer: Heritage Provider Network Senior |
$1,666.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$445.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$615.50
|
| Rate for Payer: Multiplan Commercial |
$1,846.50
|
|
|
HC BIOPSY OF SOFT TISSUE PELVIS/HIP
|
Facility
|
OP
|
$2,462.00
|
|
|
Service Code
|
CPT 27040
|
| Hospital Charge Code |
904000006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$492.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,691.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$1,354.10
|
| Rate for Payer: Cash Price |
$1,354.10
|
| Rate for Payer: Cash Price |
$1,354.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,600.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,523.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,532.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,911.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$445.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$615.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$1,846.50
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,264.55
|
| Rate for Payer: TriValley Medical Group Senior |
$2,264.55
|
| 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 |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC BIOPSY OF TONGUE
|
Facility
|
OP
|
$2,079.00
|
|
|
Service Code
|
CPT 41100
|
| Hospital Charge Code |
900541100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$415.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,428.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$1,143.45
|
| Rate for Payer: Cash Price |
$1,143.45
|
| Rate for Payer: Cash Price |
$1,143.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,351.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Senior |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$647.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,407.48
|
| Rate for Payer: Heritage Provider Network Senior |
$1,407.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$991.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$376.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$744.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$519.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$815.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$815.28
|
| Rate for Payer: Multiplan Commercial |
$1,559.25
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$748.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$688.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC BIOPSY OF TONGUE
|
Facility
|
IP
|
$2,079.00
|
|
|
Service Code
|
CPT 41100
|
| Hospital Charge Code |
900541100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$376.30 |
| Max. Negotiated Rate |
$1,559.25 |
| Rate for Payer: Adventist Health Commercial |
$415.80
|
| Rate for Payer: Cash Price |
$1,143.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,407.48
|
| Rate for Payer: Heritage Provider Network Senior |
$1,407.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$376.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$519.75
|
| Rate for Payer: Multiplan Commercial |
$1,559.25
|
|
|
HC BIOPSY/REMOVAL LYMPH NODE(S)
|
Facility
|
IP
|
$8,074.00
|
|
|
Service Code
|
CPT 38500
|
| Hospital Charge Code |
904000008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,461.39 |
| Max. Negotiated Rate |
$6,055.50 |
| Rate for Payer: Adventist Health Commercial |
$1,614.80
|
| Rate for Payer: Cash Price |
$4,440.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,466.10
|
| Rate for Payer: Heritage Provider Network Senior |
$5,466.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,461.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,018.50
|
| Rate for Payer: Multiplan Commercial |
$6,055.50
|
|
|
HC BIOPSY/REMOVAL LYMPH NODE(S)
|
Facility
|
OP
|
$8,074.00
|
|
|
Service Code
|
CPT 38500
|
| Hospital Charge Code |
904000008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,614.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,546.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,865.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$4,440.70
|
| Rate for Payer: Cash Price |
$4,440.70
|
| Rate for Payer: Cash Price |
$4,440.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,248.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,352.03
|
| Rate for Payer: Dignity Health Senior |
$4,865.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,865.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,997.81
|
| Rate for Payer: Heritage Provider Network Senior |
$5,984.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$155.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,865.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,244.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,461.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,595.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,018.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,130.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,130.50
|
| Rate for Payer: Multiplan Commercial |
$6,055.50
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,352.03
|
| Rate for Payer: TriValley Medical Group Senior |
$5,352.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Vantage Medical Group Senior |
$4,865.48
|
|
|
HC BIOPSY SINONASAL MASS PALAT
|
Facility
|
OP
|
$1,962.00
|
|
|
Service Code
|
CPT 42100
|
| Hospital Charge Code |
900501728
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$392.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,347.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$1,079.10
|
| Rate for Payer: Cash Price |
$1,079.10
|
| Rate for Payer: Cash Price |
$1,079.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,275.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Senior |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,882.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,328.27
|
| Rate for Payer: Heritage Provider Network Senior |
$1,328.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$935.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$355.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,164.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$490.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,371.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,371.46
|
| Rate for Payer: Multiplan Commercial |
$1,471.50
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$705.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$649.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
HC BIOPSY SINONASAL MASS PALAT
|
Facility
|
IP
|
$1,962.00
|
|
|
Service Code
|
CPT 42100
|
| Hospital Charge Code |
900501728
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$355.12 |
| Max. Negotiated Rate |
$1,471.50 |
| Rate for Payer: Adventist Health Commercial |
$392.40
|
| Rate for Payer: Cash Price |
$1,079.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,328.27
|
| Rate for Payer: Heritage Provider Network Senior |
$1,328.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$355.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$490.50
|
| Rate for Payer: Multiplan Commercial |
$1,471.50
|
|
|
HC BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$568.00
|
|
|
Service Code
|
CPT 11100
|
| Hospital Charge Code |
900501451
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$102.81 |
| Max. Negotiated Rate |
$426.00 |
| Rate for Payer: Adventist Health Commercial |
$113.60
|
| Rate for Payer: Cash Price |
$312.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$384.54
|
| Rate for Payer: Heritage Provider Network Senior |
$384.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.00
|
| Rate for Payer: Multiplan Commercial |
$426.00
|
|
|
HC BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$568.00
|
|
|
Service Code
|
CPT 11100
|
| Hospital Charge Code |
900501451
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$102.81 |
| Max. Negotiated Rate |
$426.00 |
| Rate for Payer: Adventist Health Commercial |
$113.60
|
| Rate for Payer: Cash Price |
$312.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$384.54
|
| Rate for Payer: Heritage Provider Network Senior |
$384.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.00
|
| Rate for Payer: Multiplan Commercial |
$426.00
|
|
|
HC BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$568.00
|
|
|
Service Code
|
CPT 11100
|
| Hospital Charge Code |
900501451
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$102.81 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$113.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$303.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$390.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$312.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$426.00
|
| 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 |
$312.40
|
| Rate for Payer: Cash Price |
$312.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$369.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$482.80
|
| Rate for Payer: Dignity Health Senior |
$482.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$351.59
|
| Rate for Payer: Heritage Provider Network Senior |
$351.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$270.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$397.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$397.60
|
| Rate for Payer: Multiplan Commercial |
$426.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$284.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$284.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$482.80
|
| Rate for Payer: Vantage Medical Group Senior |
$482.80
|
|
|
HC BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$568.00
|
|
|
Service Code
|
CPT 11100
|
| Hospital Charge Code |
900501451
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$102.81 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$113.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$303.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$390.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$312.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$426.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$312.40
|
| Rate for Payer: Cash Price |
$312.40
|
| Rate for Payer: Cash Price |
$312.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$369.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$482.80
|
| Rate for Payer: Dignity Health Senior |
$482.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$384.54
|
| Rate for Payer: Heritage Provider Network Senior |
$384.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$270.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$397.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$397.60
|
| Rate for Payer: Multiplan Commercial |
$426.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$204.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$188.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$482.80
|
| Rate for Payer: Vantage Medical Group Senior |
$482.80
|
|
|
HC BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
CPT 11100
|
| Hospital Charge Code |
909000100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$266.98 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$295.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,013.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,253.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$811.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,106.25
|
| 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 |
$811.25
|
| Rate for Payer: Cash Price |
$811.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$958.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,253.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,253.75
|
| Rate for Payer: Dignity Health Senior |
$1,253.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$913.02
|
| Rate for Payer: Heritage Provider Network Senior |
$913.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$703.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,032.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,032.50
|
| Rate for Payer: Multiplan Commercial |
$1,106.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$737.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$737.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,253.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,253.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,253.75
|
|
|
HC BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
CPT 11100
|
| Hospital Charge Code |
909000100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$266.98 |
| Max. Negotiated Rate |
$1,106.25 |
| Rate for Payer: Adventist Health Commercial |
$295.00
|
| Rate for Payer: Cash Price |
$811.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$998.58
|
| Rate for Payer: Heritage Provider Network Senior |
$998.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.75
|
| Rate for Payer: Multiplan Commercial |
$1,106.25
|
|
|
HC BIVONA ADULT AIRE-CUF 5.0
|
Facility
|
OP
|
$422.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.54 |
| Max. Negotiated Rate |
$359.44 |
| Rate for Payer: Adventist Health Commercial |
$84.57
|
| Rate for Payer: Aetna of CA Gatekeeper |
$226.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$290.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$359.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$232.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.15
|
| Rate for Payer: Blue Shield of California Commercial |
$257.95
|
| Rate for Payer: Blue Shield of California EPN |
$206.36
|
| Rate for Payer: Cash Price |
$232.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$274.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$359.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$359.44
|
| Rate for Payer: Dignity Health Senior |
$359.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.76
|
| Rate for Payer: Heritage Provider Network Senior |
$261.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$201.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$296.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$296.01
|
| Rate for Payer: Multiplan Commercial |
$317.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$211.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$211.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$359.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$359.44
|
| Rate for Payer: Vantage Medical Group Senior |
$359.44
|
|
|
HC BIVONA ADULT AIRE-CUF 5.0
|
Facility
|
IP
|
$422.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.54 |
| Max. Negotiated Rate |
$317.15 |
| Rate for Payer: Adventist Health Commercial |
$84.57
|
| Rate for Payer: Cash Price |
$232.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$286.28
|
| Rate for Payer: Heritage Provider Network Senior |
$286.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.72
|
| Rate for Payer: Multiplan Commercial |
$317.15
|
|
|
HC BIVONA ADULT AIRE-CUF 6.0
|
Facility
|
IP
|
$422.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800819
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.54 |
| Max. Negotiated Rate |
$317.15 |
| Rate for Payer: Adventist Health Commercial |
$84.57
|
| Rate for Payer: Cash Price |
$232.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$286.28
|
| Rate for Payer: Heritage Provider Network Senior |
$286.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.72
|
| Rate for Payer: Multiplan Commercial |
$317.15
|
|
|
HC BIVONA ADULT AIRE-CUF 6.0
|
Facility
|
OP
|
$422.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800819
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.54 |
| Max. Negotiated Rate |
$359.44 |
| Rate for Payer: Adventist Health Commercial |
$84.57
|
| Rate for Payer: Aetna of CA Gatekeeper |
$226.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$290.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$359.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$232.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.15
|
| Rate for Payer: Blue Shield of California Commercial |
$257.95
|
| Rate for Payer: Blue Shield of California EPN |
$206.36
|
| Rate for Payer: Cash Price |
$232.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$274.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$359.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$359.44
|
| Rate for Payer: Dignity Health Senior |
$359.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.76
|
| Rate for Payer: Heritage Provider Network Senior |
$261.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$201.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$296.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$296.01
|
| Rate for Payer: Multiplan Commercial |
$317.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$211.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$211.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$359.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$359.44
|
| Rate for Payer: Vantage Medical Group Senior |
$359.44
|
|
|
HC BIVONA CUSTOM TRACH TUBE
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.35 |
| Max. Negotiated Rate |
$1,012.50 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$913.95
|
| Rate for Payer: Heritage Provider Network Senior |
$913.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$337.50
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
|
|
HC BIVONA CUSTOM TRACH TUBE
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.35 |
| Max. Negotiated Rate |
$1,147.50 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$721.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$927.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,012.50
|
| Rate for Payer: Blue Shield of California Commercial |
$823.50
|
| Rate for Payer: Blue Shield of California EPN |
$658.80
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$877.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,147.50
|
| Rate for Payer: Dignity Health Senior |
$1,147.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$835.65
|
| Rate for Payer: Heritage Provider Network Senior |
$835.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$643.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$337.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$945.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$945.00
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$675.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$675.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,147.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,147.50
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 2.5
|
Facility
|
OP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.53 |
| Max. Negotiated Rate |
$711.62 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$447.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$575.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$460.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$627.90
|
| Rate for Payer: Blue Shield of California Commercial |
$510.69
|
| Rate for Payer: Blue Shield of California EPN |
$408.55
|
| Rate for Payer: Cash Price |
$460.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$544.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$711.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.62
|
| Rate for Payer: Dignity Health Senior |
$711.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$544.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$518.23
|
| Rate for Payer: Heritage Provider Network Senior |
$518.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$399.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$586.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$586.04
|
| Rate for Payer: Multiplan Commercial |
$627.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$418.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$418.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.62
|
| Rate for Payer: Vantage Medical Group Senior |
$711.62
|
|
