|
HC DRAIN EXT EAR ABSC SIMPLE
|
Facility
|
IP
|
$666.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
900501184
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.55 |
| Max. Negotiated Rate |
$499.50 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$450.88
|
| Rate for Payer: Heritage Provider Network Senior |
$450.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.50
|
| Rate for Payer: Multiplan Commercial |
$499.50
|
|
|
HC DRAIN EXT EAR ABSC SIMPLE
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
900501184
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$457.54
|
| 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 |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$432.90
|
| 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 |
$432.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$893.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$450.88
|
| Rate for Payer: Heritage Provider Network Senior |
$450.88
|
| 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 |
$317.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,028.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.50
|
| 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 |
$499.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$239.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.51
|
| 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 FINGER ABSCESS COMPL
|
Facility
|
OP
|
$2,314.00
|
|
|
Service Code
|
CPT 26011
|
| Hospital Charge Code |
900501073
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$462.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,589.72
|
| 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 |
$1,272.70
|
| Rate for Payer: Cash Price |
$1,272.70
|
| Rate for Payer: Cash Price |
$1,272.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,504.10
|
| 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 |
$1,566.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,566.58
|
| 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 |
$1,103.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$418.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.50
|
| 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 |
$1,735.50
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$832.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$766.17
|
| 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 FINGER ABSCESS COMPL
|
Facility
|
IP
|
$2,314.00
|
|
|
Service Code
|
CPT 26011
|
| Hospital Charge Code |
900501073
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$418.83 |
| Max. Negotiated Rate |
$1,735.50 |
| Rate for Payer: Adventist Health Commercial |
$462.80
|
| Rate for Payer: Cash Price |
$1,272.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,566.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,566.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$418.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.50
|
| Rate for Payer: Multiplan Commercial |
$1,735.50
|
|
|
HC DRAIN FINGER ABSCESS, SIMPLE
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
900501461
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$366.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$470.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$376.75
|
| Rate for Payer: Cash Price |
$376.75
|
| Rate for Payer: Cash Price |
$376.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$445.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Senior |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$252.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.75
|
| Rate for Payer: Heritage Provider Network Senior |
$463.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$326.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.11
|
| Rate for Payer: Multiplan Commercial |
$513.75
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$246.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$226.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC DRAIN FINGER ABSCESS, SIMPLE
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
900501461
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$513.75 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Cash Price |
$376.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.75
|
| Rate for Payer: Heritage Provider Network Senior |
$463.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.25
|
| Rate for Payer: Multiplan Commercial |
$513.75
|
|
|
HC DRAIN JP
|
Facility
|
IP
|
$35.09
|
|
| Hospital Charge Code |
909020083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$26.32 |
| Rate for Payer: Adventist Health Commercial |
$7.02
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.76
|
| Rate for Payer: Heritage Provider Network Senior |
$23.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.77
|
| Rate for Payer: Multiplan Commercial |
$26.32
|
|
|
HC DRAIN JP
|
Facility
|
OP
|
$35.09
|
|
| Hospital Charge Code |
909020083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$29.83 |
| Rate for Payer: Adventist Health Commercial |
$7.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.32
|
| Rate for Payer: Blue Shield of California Commercial |
$21.40
|
| Rate for Payer: Blue Shield of California EPN |
$17.12
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.83
|
| Rate for Payer: Dignity Health Senior |
$29.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.72
|
| Rate for Payer: Heritage Provider Network Senior |
$21.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.56
|
| Rate for Payer: Multiplan Commercial |
$26.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.83
|
| Rate for Payer: Vantage Medical Group Senior |
$29.83
|
|
|
HC DRES & OR DEB OF BURN INT/SUB LG
|
Facility
|
OP
|
$1,298.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
900501048
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$259.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$891.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$713.90
|
| Rate for Payer: Cash Price |
$713.90
|
| Rate for Payer: Cash Price |
$713.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$843.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Senior |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$878.75
|
| Rate for Payer: Heritage Provider Network Senior |
$878.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$619.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$639.63
|
| Rate for Payer: Multiplan Commercial |
$973.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$467.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$429.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC DRES & OR DEB OF BURN INT/SUB LG
|
Facility
|
IP
|
$1,298.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
900501048
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$234.94 |
| Max. Negotiated Rate |
$973.50 |
| Rate for Payer: Adventist Health Commercial |
$259.60
|
| Rate for Payer: Cash Price |
$713.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$878.75
|
| Rate for Payer: Heritage Provider Network Senior |
$878.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.50
|
| Rate for Payer: Multiplan Commercial |
$973.50
|
|
|
HC DRES & OR DEB OF BURN INT/SUB MED
|
Facility
|
OP
|
$996.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
900501047
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$199.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$684.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$647.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Senior |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$252.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$674.29
|
| Rate for Payer: Heritage Provider Network Senior |
$674.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$475.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.11
|
| Rate for Payer: Multiplan Commercial |
$747.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$358.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$329.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC DRES & OR DEB OF BURN INT/SUB MED
|
Facility
|
IP
|
$996.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
900501047
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$180.28 |
| Max. Negotiated Rate |
$747.00 |
| Rate for Payer: Adventist Health Commercial |
$199.20
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$674.29
|
| Rate for Payer: Heritage Provider Network Senior |
$674.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.00
|
| Rate for Payer: Multiplan Commercial |
$747.00
|
|
|
HC DRES & OR DEB OF BURN INT/SUB SMALL
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
900501046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$515.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$487.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Senior |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$252.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$507.75
|
| Rate for Payer: Heritage Provider Network Senior |
$507.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$357.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.11
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$269.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$248.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC DRES & OR DEB OF BURN INT/SUB SMALL
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
900501046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.75 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$507.75
|
| Rate for Payer: Heritage Provider Network Senior |
$507.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.50
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
|
|
HC DRESSING CHANGE UNDER ANESTH
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
CPT 15852
|
| Hospital Charge Code |
907201139
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.45 |
| Max. Negotiated Rate |
$416.25 |
| Rate for Payer: Adventist Health Commercial |
$111.00
|
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.74
|
| Rate for Payer: Heritage Provider Network Senior |
$375.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.75
|
| Rate for Payer: Multiplan Commercial |
$416.25
|
|
|
HC DRESSING CHANGE UNDER ANESTH
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT 15852
|
| Hospital Charge Code |
907201139
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$111.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$381.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$360.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Senior |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$777.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.74
|
| Rate for Payer: Heritage Provider Network Senior |
$375.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$264.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$894.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$979.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$979.99
|
| Rate for Payer: Multiplan Commercial |
$416.25
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$199.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$183.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC DRIED BLOOD SPOT SCREEN DUKE
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900914678
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$99.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.86
|
| Rate for Payer: Blue Shield of California Commercial |
$56.28
|
| Rate for Payer: Blue Shield of California EPN |
$45.14
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$94.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.91
|
| Rate for Payer: Dignity Health Senior |
$8.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$89.75
|
| Rate for Payer: Heritage Provider Network Senior |
$89.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$69.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.21
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.10
|
| Rate for Payer: TriValley Medical Group Senior |
$8.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Vantage Medical Group Senior |
$8.10
|
|
|
HC DRIED BLOOD SPOT SCREEN DUKE
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900914678
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$98.17
|
| Rate for Payer: Heritage Provider Network Senior |
$98.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.25
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
|
|
HC DRILL SKULL FOR IMPLANTATION
|
Facility
|
OP
|
$11,512.00
|
|
|
Service Code
|
CPT 61107
|
| Hospital Charge Code |
900501647
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$506.62 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,302.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,908.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,785.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,331.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,634.00
|
| 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 |
$6,331.60
|
| Rate for Payer: Cash Price |
$6,331.60
|
| Rate for Payer: Cash Price |
$6,331.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,482.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,785.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,785.20
|
| Rate for Payer: Dignity Health Senior |
$9,785.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,907.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,125.93
|
| Rate for Payer: Heritage Provider Network Senior |
$7,125.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$506.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,491.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,083.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,878.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,058.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,058.40
|
| Rate for Payer: Multiplan Commercial |
$8,634.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,785.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,785.20
|
| Rate for Payer: Vantage Medical Group Senior |
$9,785.20
|
|
|
HC DRILL SKULL FOR IMPLANTATION
|
Facility
|
IP
|
$11,512.00
|
|
|
Service Code
|
CPT 61107
|
| Hospital Charge Code |
900501647
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,083.67 |
| Max. Negotiated Rate |
$8,634.00 |
| Rate for Payer: Adventist Health Commercial |
$2,302.40
|
| Rate for Payer: Cash Price |
$6,331.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,793.62
|
| Rate for Payer: Heritage Provider Network Senior |
$7,793.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,083.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,878.00
|
| Rate for Payer: Multiplan Commercial |
$8,634.00
|
|
|
HC DRSNG CAL AG MELGISORB+ 4X4"
|
Facility
|
IP
|
$15.76
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
901698367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$11.82 |
| Rate for Payer: Adventist Health Commercial |
$3.15
|
| Rate for Payer: Cash Price |
$8.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.67
|
| Rate for Payer: Heritage Provider Network Senior |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.94
|
| Rate for Payer: Multiplan Commercial |
$11.82
|
|
|
HC DRSNG CAL AG MELGISORB+ 4X4"
|
Facility
|
OP
|
$15.76
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
901698367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$13.40 |
| Rate for Payer: Adventist Health Commercial |
$3.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.82
|
| Rate for Payer: Blue Shield of California Commercial |
$9.61
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Cash Price |
$8.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.40
|
| Rate for Payer: Dignity Health Senior |
$13.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.76
|
| Rate for Payer: Heritage Provider Network Senior |
$9.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.03
|
| Rate for Payer: Multiplan Commercial |
$11.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.40
|
| Rate for Payer: Vantage Medical Group Senior |
$13.40
|
|
|
HC DRSNG KERECIS OMEGA 3 WOUND 1.75X1.75CM
|
Facility
|
OP
|
$826.00
|
|
|
Service Code
|
CPT Q4158
|
| Hospital Charge Code |
900102212
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.62 |
| Max. Negotiated Rate |
$702.10 |
| Rate for Payer: Adventist Health Commercial |
$165.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$441.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$567.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$702.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$454.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$619.50
|
| Rate for Payer: Blue Shield of California Commercial |
$503.86
|
| Rate for Payer: Blue Shield of California EPN |
$403.09
|
| Rate for Payer: Cash Price |
$454.30
|
| Rate for Payer: Cash Price |
$454.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$379.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$702.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$702.10
|
| Rate for Payer: Dignity Health Senior |
$702.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$528.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$382.44
|
| Rate for Payer: Heritage Provider Network Senior |
$382.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$394.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$578.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$578.20
|
| Rate for Payer: Multiplan Commercial |
$619.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$330.40
|
| Rate for Payer: TriValley Medical Group Senior |
$330.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$298.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$273.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$702.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$702.10
|
| Rate for Payer: Vantage Medical Group Senior |
$702.10
|
|
|
HC DRSNG KERECIS OMEGA 3 WOUND 1.75X1.75CM
|
Facility
|
IP
|
$826.00
|
|
|
Service Code
|
CPT Q4158
|
| Hospital Charge Code |
900102212
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$149.51 |
| Max. Negotiated Rate |
$619.50 |
| Rate for Payer: Adventist Health Commercial |
$165.20
|
| Rate for Payer: Cash Price |
$454.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$379.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$446.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$382.44
|
| Rate for Payer: Heritage Provider Network Senior |
$382.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.50
|
| Rate for Payer: Multiplan Commercial |
$619.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$298.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$273.49
|
|
|
HC DRSNG KERECIS OMEGA 3 WOUND 3 X 3.5CM
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT Q4158
|
| Hospital Charge Code |
900102213
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$282.20 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$177.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$228.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$282.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$249.00
|
| Rate for Payer: Blue Shield of California Commercial |
$202.52
|
| Rate for Payer: Blue Shield of California EPN |
$162.02
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$152.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$282.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$282.20
|
| Rate for Payer: Dignity Health Senior |
$282.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$153.72
|
| Rate for Payer: Heritage Provider Network Senior |
$153.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$158.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$232.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$232.40
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$132.80
|
| Rate for Payer: TriValley Medical Group Senior |
$132.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$119.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$109.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$282.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$282.20
|
| Rate for Payer: Vantage Medical Group Senior |
$282.20
|
|
