|
HC EXC BEN LES TRUNK LT 0.5 CM
|
Facility
|
IP
|
$1,128.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
900501287
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.17 |
| Max. Negotiated Rate |
$846.00 |
| Rate for Payer: Adventist Health Commercial |
$225.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$774.94
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$763.66
|
| Rate for Payer: Heritage Provider Network Senior |
$763.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.00
|
| Rate for Payer: Multiplan Commercial |
$846.00
|
|
|
HC EXC FACIAL LESION 0.6-1.0 CM
|
Facility
|
IP
|
$1,366.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
900501588
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$247.25 |
| Max. Negotiated Rate |
$1,024.50 |
| Rate for Payer: Adventist Health Commercial |
$273.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$938.44
|
| Rate for Payer: Cash Price |
$614.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$924.78
|
| Rate for Payer: Heritage Provider Network Senior |
$924.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.50
|
| Rate for Payer: Multiplan Commercial |
$1,024.50
|
|
|
HC EXC FACIAL LESION 0.6-1.0 CM
|
Facility
|
OP
|
$1,366.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
900501588
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$247.25 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$273.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$938.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$614.70
|
| Rate for Payer: Cash Price |
$614.70
|
| Rate for Payer: Cash Price |
$614.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$887.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$924.78
|
| Rate for Payer: Heritage Provider Network Senior |
$924.78
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$658.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$1,024.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$495.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$456.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC EXCHANGE STEERABLE GW
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$157.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Blue Shield of California Commercial |
$186.30
|
| Rate for Payer: Blue Shield of California EPN |
$176.10
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$195.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Senior |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$185.70
|
| Rate for Payer: Heritage Provider Network Senior |
$185.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$144.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC EXCHANGE STEERABLE GW
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.10
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.10
|
| Rate for Payer: Heritage Provider Network Senior |
$203.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
|
|
HC EXCISION OF GUM LESION
|
Facility
|
OP
|
$3,581.00
|
|
|
Service Code
|
CPT 41825
|
| Hospital Charge Code |
900501744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$648.16 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$716.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,460.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,611.45
|
| Rate for Payer: Cash Price |
$1,611.45
|
| Rate for Payer: Cash Price |
$1,611.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,327.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: Dignity Health Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,022.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,424.34
|
| Rate for Payer: Heritage Provider Network Senior |
$2,424.34
|
| Rate for Payer: Humana Medicare |
$4,022.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,726.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$648.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,746.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$895.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,068.59
|
| Rate for Payer: Multiplan Commercial |
$2,685.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,300.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,196.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC EXCISION OF GUM LESION
|
Facility
|
IP
|
$3,581.00
|
|
|
Service Code
|
CPT 41825
|
| Hospital Charge Code |
900501744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$648.16 |
| Max. Negotiated Rate |
$2,685.75 |
| Rate for Payer: Adventist Health Commercial |
$716.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,460.15
|
| Rate for Payer: Cash Price |
$1,611.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,424.34
|
| Rate for Payer: Heritage Provider Network Senior |
$2,424.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$648.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$895.25
|
| Rate for Payer: Multiplan Commercial |
$2,685.75
|
|
|
HC EXCISION OF LINGUAL FRENUM
|
Facility
|
IP
|
$1,613.00
|
|
|
Service Code
|
CPT 41115
|
| Hospital Charge Code |
900501757
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.95 |
| Max. Negotiated Rate |
$1,209.75 |
| Rate for Payer: Adventist Health Commercial |
$322.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,108.13
|
| Rate for Payer: Cash Price |
$725.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,092.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,092.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.25
|
| Rate for Payer: Multiplan Commercial |
$1,209.75
|
|
|
HC EXCISION OF LINGUAL FRENUM
|
Facility
|
OP
|
$1,613.00
|
|
|
Service Code
|
CPT 41115
|
| Hospital Charge Code |
900501757
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.95 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$322.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,108.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$725.85
|
| Rate for Payer: Cash Price |
$725.85
|
| Rate for Payer: Cash Price |
$725.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,048.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: Dignity Health Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,905.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,092.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,092.00
|
| Rate for Payer: Humana Medicare |
$1,905.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$777.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,248.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,400.85
|
| Rate for Payer: Multiplan Commercial |
$1,209.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$585.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$538.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC EXCISION/REPAIR EYELID GT 1/4
|
Facility
|
IP
|
$4,568.00
|
|
|
Service Code
|
CPT 67966
|
| Hospital Charge Code |
900501712
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$826.81 |
| Max. Negotiated Rate |
$3,426.00 |
| Rate for Payer: Adventist Health Commercial |
$913.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,138.22
|
| Rate for Payer: Cash Price |
$2,055.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,092.54
|
| Rate for Payer: Heritage Provider Network Senior |
$3,092.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$826.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,142.00
|
| Rate for Payer: Multiplan Commercial |
$3,426.00
|
|
|
HC EXCISION/REPAIR EYELID GT 1/4
|
Facility
|
OP
|
$4,568.00
|
|
|
Service Code
|
CPT 67966
|
| Hospital Charge Code |
900501712
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$826.81 |
| Max. Negotiated Rate |
$5,505.00 |
| Rate for Payer: Adventist Health Commercial |
$913.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,138.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$2,055.60
|
| Rate for Payer: Cash Price |
$2,055.60
|
| Rate for Payer: Cash Price |
$2,055.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,969.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: Dignity Health Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,969.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,919.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,092.54
|
| Rate for Payer: Heritage Provider Network Senior |
$3,092.54
|
| Rate for Payer: Humana Medicare |
$2,919.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,919.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,201.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$826.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,445.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,142.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,678.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,678.78
|
| Rate for Payer: Multiplan Commercial |
$3,426.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,658.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,526.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
HC EXCISION TONGUE LESION W/O CLOSURE
|
Facility
|
OP
|
$3,556.00
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
900501147
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$643.64 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$711.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,442.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,600.20
|
| Rate for Payer: Cash Price |
$1,600.20
|
| Rate for Payer: Cash Price |
$1,600.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,311.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: Dignity Health Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,022.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,407.41
|
| Rate for Payer: Heritage Provider Network Senior |
$2,407.41
|
| Rate for Payer: Humana Medicare |
$4,022.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,713.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,746.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$889.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,068.59
|
| Rate for Payer: Multiplan Commercial |
$2,667.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,291.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,188.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC EXCISION TONGUE LESION W/O CLOSURE
|
Facility
|
IP
|
$3,556.00
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
900501147
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$643.64 |
| Max. Negotiated Rate |
$2,667.00 |
| Rate for Payer: Adventist Health Commercial |
$711.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,442.97
|
| Rate for Payer: Cash Price |
$1,600.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,407.41
|
| Rate for Payer: Heritage Provider Network Senior |
$2,407.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$889.00
|
| Rate for Payer: Multiplan Commercial |
$2,667.00
|
|
|
HC EXCSN EXT THROMBOTC HEMORRHOID
|
Facility
|
OP
|
$4,985.00
|
|
|
Service Code
|
CPT 46320
|
| Hospital Charge Code |
900501158
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$902.28 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$997.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,424.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$2,243.25
|
| Rate for Payer: Cash Price |
$2,243.25
|
| Rate for Payer: Cash Price |
$2,243.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,240.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.86
|
| Rate for Payer: Dignity Health Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,474.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,374.84
|
| Rate for Payer: Heritage Provider Network Senior |
$3,374.84
|
| Rate for Payer: Humana Medicare |
$1,474.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,474.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,402.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$902.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,246.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,857.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,857.77
|
| Rate for Payer: Multiplan Commercial |
$3,738.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,810.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,665.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC EXCSN EXT THROMBOTC HEMORRHOID
|
Facility
|
IP
|
$4,985.00
|
|
|
Service Code
|
CPT 46320
|
| Hospital Charge Code |
900501158
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$902.28 |
| Max. Negotiated Rate |
$3,738.75 |
| Rate for Payer: Adventist Health Commercial |
$997.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,424.70
|
| Rate for Payer: Cash Price |
$2,243.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,374.84
|
| Rate for Payer: Heritage Provider Network Senior |
$3,374.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$902.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,246.25
|
| Rate for Payer: Multiplan Commercial |
$3,738.75
|
|
|
HC EXC TST BRNCHSPSM WO EC RCRDG
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 94619
|
| Hospital Charge Code |
900894619
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$145.20 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$120.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$124.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Blue Shield of California Commercial |
$112.40
|
| Rate for Payer: Blue Shield of California EPN |
$106.25
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$117.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: Dignity Health Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.04
|
| Rate for Payer: Heritage Provider Network Senior |
$112.04
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$103.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.29
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$84.06
|
| Rate for Payer: TriValley Medical Group Senior |
$76.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC EXC TST BRNCHSPSM WO EC RCRDG
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 94619
|
| Hospital Charge Code |
900894619
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$135.75 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$124.35
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.54
|
| Rate for Payer: Heritage Provider Network Senior |
$122.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.25
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
|
|
HC EXERCISE TEST BRONCHOSPASM
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 94617
|
| Hospital Charge Code |
900894620
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$303.24 |
| Rate for Payer: Adventist Health Commercial |
$69.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$150.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$237.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Blue Shield of California Commercial |
$214.24
|
| Rate for Payer: Blue Shield of California EPN |
$202.52
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$224.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.56
|
| Rate for Payer: Heritage Provider Network Senior |
$213.56
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$134.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$258.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.56
|
| Rate for Payer: TriValley Medical Group Senior |
$159.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC EXERCISE TEST BRONCHOSPASM
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 94617
|
| Hospital Charge Code |
900894620
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$258.75 |
| Rate for Payer: Adventist Health Commercial |
$69.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$237.02
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$233.56
|
| Rate for Payer: Heritage Provider Network Senior |
$233.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.25
|
| Rate for Payer: Multiplan Commercial |
$258.75
|
|
|
HC EX FOR SPEECH DEVICE RX ADDL
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
905601817
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$49.05 |
| Max. Negotiated Rate |
$203.25 |
| Rate for Payer: Adventist Health Commercial |
$54.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$186.18
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.47
|
| Rate for Payer: Heritage Provider Network Senior |
$183.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.75
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
|
|
HC EX FOR SPEECH DEVICE RX ADDL
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
905601817
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$29.33 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$54.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$121.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$186.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$230.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$149.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$203.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$176.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$230.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$230.35
|
| Rate for Payer: Dignity Health Senior |
$230.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.75
|
| Rate for Payer: Heritage Provider Network Senior |
$167.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$130.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.75
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$230.35
|
| Rate for Payer: Vantage Medical Group Senior |
$230.35
|
|
|
HC EX OF NAIL & MAT PART OR COMP
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
900501017
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$205.25 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$226.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$779.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$737.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$767.72
|
| Rate for Payer: Heritage Provider Network Senior |
$767.72
|
| Rate for Payer: Humana Medicare |
$498.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$546.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$850.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$411.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$378.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC EX OF NAIL & MAT PART OR COMP
|
Facility
|
IP
|
$1,134.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
900501017
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$205.25 |
| Max. Negotiated Rate |
$850.50 |
| Rate for Payer: Adventist Health Commercial |
$226.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$779.06
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$767.72
|
| Rate for Payer: Heritage Provider Network Senior |
$767.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.50
|
| Rate for Payer: Multiplan Commercial |
$850.50
|
|
|
HC EXPIRED CO2 DETERM
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800910
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$72.58 |
| Max. Negotiated Rate |
$300.75 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$275.49
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$271.48
|
| Rate for Payer: Heritage Provider Network Senior |
$271.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.25
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
|
|
HC EXPIRED CO2 DETERM
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800910
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$72.58 |
| Max. Negotiated Rate |
$370.82 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$214.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$275.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Blue Shield of California Commercial |
$249.02
|
| Rate for Payer: Blue Shield of California EPN |
$235.39
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$260.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$248.22
|
| Rate for Payer: Heritage Provider Network Senior |
$248.22
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$214.69
|
| Rate for Payer: TriValley Medical Group Senior |
$195.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
