|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906820031
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$111.86 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$123.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$330.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$424.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| 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 |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Senior |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$421.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$382.54
|
| Rate for Payer: Heritage Provider Network Senior |
$518.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$404.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$421.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$800.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$531.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$531.03
|
| Rate for Payer: Multiplan Commercial |
$463.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$463.60
|
| Rate for Payer: TriValley Medical Group Senior |
$421.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.03 |
| Max. Negotiated Rate |
$393.75 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$355.43
|
| Rate for Payer: Heritage Provider Network Senior |
$355.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.25
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$95.03 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.25
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.03 |
| Max. Negotiated Rate |
$6,004.00 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$280.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$360.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$341.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Senior |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$421.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$355.43
|
| Rate for Payer: Heritage Provider Network Senior |
$355.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$421.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$250.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$531.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$531.03
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$188.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$173.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$95.03 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$280.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$360.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| 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 |
$288.75
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Senior |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$421.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$324.98
|
| Rate for Payer: Heritage Provider Network Senior |
$518.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$404.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$421.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$800.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$531.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$531.03
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$463.60
|
| Rate for Payer: TriValley Medical Group Senior |
$421.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC DISTRTN NEUROLTC AGT GNCLR NRV
|
Facility
|
OP
|
$5,232.00
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
909004624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,046.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,594.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| 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 |
$2,877.60
|
| Rate for Payer: Cash Price |
$2,877.60
|
| Rate for Payer: Cash Price |
$2,877.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,400.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Senior |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,139.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,481.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,238.61
|
| Rate for Payer: Heritage Provider Network Senior |
$3,051.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$607.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,714.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$946.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,853.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,308.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,126.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,126.30
|
| Rate for Payer: Multiplan Commercial |
$3,924.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,729.31
|
| Rate for Payer: TriValley Medical Group Senior |
$2,729.31
|
| 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 |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC DISTRTN NEUROLTC AGT GNCLR NRV
|
Facility
|
IP
|
$5,232.00
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
909004624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$946.99 |
| Max. Negotiated Rate |
$3,924.00 |
| Rate for Payer: Adventist Health Commercial |
$1,046.40
|
| Rate for Payer: Cash Price |
$2,877.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,542.06
|
| Rate for Payer: Heritage Provider Network Senior |
$3,542.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$946.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,308.00
|
| Rate for Payer: Multiplan Commercial |
$3,924.00
|
|
|
HC DNA AB DBL STRANDED
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
900913520
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$160.50 |
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Cash Price |
$117.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.88
|
| Rate for Payer: Heritage Provider Network Senior |
$144.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.50
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
|
|
HC DNA AB DBL STRANDED
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
900913520
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$160.50 |
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$114.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$147.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.45
|
| Rate for Payer: Blue Shield of California Commercial |
$110.59
|
| Rate for Payer: Blue Shield of California EPN |
$88.70
|
| Rate for Payer: Cash Price |
$117.70
|
| Rate for Payer: Cash Price |
$117.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$139.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.11
|
| Rate for Payer: Dignity Health Senior |
$13.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.47
|
| Rate for Payer: Heritage Provider Network Senior |
$132.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$102.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.31
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.74
|
| Rate for Payer: TriValley Medical Group Senior |
$13.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Vantage Medical Group Senior |
$13.74
|
|
|
HC DOPPLER
|
Facility
|
OP
|
$1,794.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
906601558
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$304.30 |
| Max. Negotiated Rate |
$1,345.50 |
| Rate for Payer: Adventist Health Commercial |
$358.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$958.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,232.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Blue Shield of California Commercial |
$1,116.58
|
| Rate for Payer: Blue Shield of California EPN |
$897.91
|
| Rate for Payer: Cash Price |
$986.70
|
| Rate for Payer: Cash Price |
$986.70
|
| Rate for Payer: Cash Price |
$986.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,166.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,110.49
|
| Rate for Payer: Heritage Provider Network Senior |
$1,110.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$304.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$855.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$1,345.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$337.84
|
| Rate for Payer: TriValley Medical Group Senior |
$307.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC DOPPLER
|
Facility
|
IP
|
$1,794.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
906601558
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$324.71 |
| Max. Negotiated Rate |
$1,345.50 |
| Rate for Payer: Adventist Health Commercial |
$358.80
|
| Rate for Payer: Cash Price |
$986.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,214.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,214.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.50
|
| Rate for Payer: Multiplan Commercial |
$1,345.50
|
|
|
HC DRAIN ABSCESS CYST HEM VISTIB
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
900501236
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.08 |
| Max. Negotiated Rate |
$597.00 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$538.89
|
| Rate for Payer: Heritage Provider Network Senior |
$538.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.00
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
|
|
HC DRAIN ABSCESS CYST HEM VISTIB
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
900501236
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.08 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$425.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$546.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$517.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Senior |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$893.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$538.89
|
| Rate for Payer: Heritage Provider Network Senior |
$538.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$379.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,028.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,126.41
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$286.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$263.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC DRAIN ABSCESS/HEMATOMA,NASAL
|
Facility
|
IP
|
$754.00
|
|
|
Service Code
|
CPT 30020
|
| Hospital Charge Code |
900501594
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.47 |
| Max. Negotiated Rate |
$565.50 |
| Rate for Payer: Adventist Health Commercial |
$150.80
|
| Rate for Payer: Cash Price |
$414.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$510.46
|
| Rate for Payer: Heritage Provider Network Senior |
$510.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.50
|
| Rate for Payer: Multiplan Commercial |
$565.50
|
|
|
HC DRAIN ABSCESS/HEMATOMA,NASAL
|
Facility
|
OP
|
$754.00
|
|
|
Service Code
|
CPT 30020
|
| Hospital Charge Code |
900501594
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$150.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$518.00
|
| 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 |
$414.70
|
| Rate for Payer: Cash Price |
$414.70
|
| Rate for Payer: Cash Price |
$414.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$490.10
|
| 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 |
$510.46
|
| Rate for Payer: Heritage Provider Network Senior |
$510.46
|
| 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 |
$359.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$744.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.50
|
| 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 |
$565.50
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$271.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$249.65
|
| 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 DRAIN ABSCESS PALATE UVULA
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
CPT 42000
|
| Hospital Charge Code |
900501466
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.30 |
| Max. Negotiated Rate |
$556.50 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Cash Price |
$408.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.33
|
| Rate for Payer: Heritage Provider Network Senior |
$502.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$556.50
|
|
|
HC DRAIN ABSCESS PALATE UVULA
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
CPT 42000
|
| Hospital Charge Code |
900501466
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$509.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$408.10
|
| Rate for Payer: Cash Price |
$408.10
|
| Rate for Payer: Cash Price |
$408.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$482.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Senior |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$295.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.33
|
| Rate for Payer: Heritage Provider Network Senior |
$502.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$353.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.78
|
| Rate for Payer: Multiplan Commercial |
$556.50
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$266.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$245.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC DRAINAGE OF EYE
|
Facility
|
IP
|
$9,492.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
900501746
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,718.05 |
| Max. Negotiated Rate |
$7,119.00 |
| Rate for Payer: Adventist Health Commercial |
$1,898.40
|
| Rate for Payer: Cash Price |
$5,220.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,426.08
|
| Rate for Payer: Heritage Provider Network Senior |
$6,426.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,718.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,373.00
|
| Rate for Payer: Multiplan Commercial |
$7,119.00
|
|
|
HC DRAINAGE OF EYE
|
Facility
|
OP
|
$9,492.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
900501746
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$7,119.00 |
| Rate for Payer: Adventist Health Commercial |
$1,898.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,521.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$5,220.60
|
| Rate for Payer: Cash Price |
$5,220.60
|
| Rate for Payer: Cash Price |
$5,220.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,169.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Senior |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,169.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,897.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,426.08
|
| Rate for Payer: Heritage Provider Network Senior |
$6,426.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,527.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,718.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,332.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,373.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,651.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,651.35
|
| Rate for Payer: Multiplan Commercial |
$7,119.00
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,415.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,142.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC DRAINAGE OF SALIVARY GLAND
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
CPT 42320
|
| Hospital Charge Code |
900501363
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$147.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$504.94
|
| 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 |
$404.25
|
| Rate for Payer: Cash Price |
$404.25
|
| Rate for Payer: Cash Price |
$404.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$477.75
|
| 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 |
$497.60
|
| Rate for Payer: Heritage Provider Network Senior |
$497.60
|
| 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 |
$350.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$744.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.75
|
| 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 |
$551.25
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$264.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$243.36
|
| 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 DRAINAGE OF SALIVARY GLAND
|
Facility
|
IP
|
$735.00
|
|
|
Service Code
|
CPT 42320
|
| Hospital Charge Code |
900501363
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$133.03 |
| Max. Negotiated Rate |
$551.25 |
| Rate for Payer: Adventist Health Commercial |
$147.00
|
| Rate for Payer: Cash Price |
$404.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$497.60
|
| Rate for Payer: Heritage Provider Network Senior |
$497.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.75
|
| Rate for Payer: Multiplan Commercial |
$551.25
|
|
|
HC DRAINAGE/ SCROTAL WALL ABSCESS
|
Facility
|
IP
|
$4,718.00
|
|
|
Service Code
|
CPT 55100
|
| Hospital Charge Code |
900501614
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$853.96 |
| Max. Negotiated Rate |
$3,538.50 |
| Rate for Payer: Adventist Health Commercial |
$943.60
|
| Rate for Payer: Cash Price |
$2,594.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,194.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3,194.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$853.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,179.50
|
| Rate for Payer: Multiplan Commercial |
$3,538.50
|
|
|
HC DRAINAGE/ SCROTAL WALL ABSCESS
|
Facility
|
OP
|
$4,718.00
|
|
|
Service Code
|
CPT 55100
|
| Hospital Charge Code |
900501614
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$943.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,241.27
|
| 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: Cash Price |
$2,594.90
|
| Rate for Payer: Cash Price |
$2,594.90
|
| Rate for Payer: Cash Price |
$2,594.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,066.70
|
| 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 |
$3,194.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3,194.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,250.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$853.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,179.50
|
| 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 |
$3,538.50
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,697.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,562.13
|
| 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 DRAIN CATH PLCMT HEMATOMA/SEROMA/CYST
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT 10030
|
| Hospital Charge Code |
909020024
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$563.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| 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 |
$451.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$533.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Senior |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$893.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$507.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,099.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$215.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,698.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,028.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,126.41
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$983.38
|
| Rate for Payer: TriValley Medical Group Senior |
$983.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC DRAIN CATH PLCMT HEMATOMA/SEROMA/CYST
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
CPT 10030
|
| Hospital Charge Code |
909020024
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$148.42 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$555.14
|
| Rate for Payer: Heritage Provider Network Senior |
$555.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
|
