|
HC I & D ABSCESS,THROAT INTRAORAL
|
Facility
|
OP
|
$4,886.00
|
|
|
Service Code
|
CPT 42720
|
| Hospital Charge Code |
900501607
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$884.37 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$977.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,356.68
|
| 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 |
$2,198.70
|
| Rate for Payer: Cash Price |
$2,198.70
|
| Rate for Payer: Cash Price |
$2,198.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,175.90
|
| 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 |
$3,307.82
|
| Rate for Payer: Heritage Provider Network Senior |
$3,307.82
|
| 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 |
$2,355.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$884.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,746.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,221.50
|
| 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 |
$3,664.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,774.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,632.41
|
| 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 I & D ABSCESS,THROAT INTRAORAL
|
Facility
|
IP
|
$4,886.00
|
|
|
Service Code
|
CPT 42720
|
| Hospital Charge Code |
900501607
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$884.37 |
| Max. Negotiated Rate |
$3,664.50 |
| Rate for Payer: Adventist Health Commercial |
$977.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,356.68
|
| Rate for Payer: Cash Price |
$2,198.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,307.82
|
| Rate for Payer: Heritage Provider Network Senior |
$3,307.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$884.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,221.50
|
| Rate for Payer: Multiplan Commercial |
$3,664.50
|
|
|
HC I & D ARM BURSA
|
Facility
|
IP
|
$3,909.00
|
|
|
Service Code
|
CPT 23931
|
| Hospital Charge Code |
900501660
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$707.53 |
| Max. Negotiated Rate |
$2,931.75 |
| Rate for Payer: Adventist Health Commercial |
$781.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,685.48
|
| Rate for Payer: Cash Price |
$1,759.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,646.39
|
| Rate for Payer: Heritage Provider Network Senior |
$2,646.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$707.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$977.25
|
| Rate for Payer: Multiplan Commercial |
$2,931.75
|
|
|
HC I & D ARM BURSA
|
Facility
|
OP
|
$3,909.00
|
|
|
Service Code
|
CPT 23931
|
| Hospital Charge Code |
900501660
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$707.53 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$781.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,685.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$1,759.05
|
| Rate for Payer: Cash Price |
$1,759.05
|
| Rate for Payer: Cash Price |
$1,759.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,540.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,646.39
|
| Rate for Payer: Heritage Provider Network Senior |
$2,646.39
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,884.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$707.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$977.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$2,931.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,419.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,306.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC I&D BARTHOLIN ABSC
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
CPT 56420
|
| Hospital Charge Code |
900501169
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$139.55 |
| Max. Negotiated Rate |
$578.25 |
| Rate for Payer: Adventist Health Commercial |
$154.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$529.68
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$521.97
|
| Rate for Payer: Heritage Provider Network Senior |
$521.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.75
|
| Rate for Payer: Multiplan Commercial |
$578.25
|
|
|
HC I&D BARTHOLIN ABSC
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT 56420
|
| Hospital Charge Code |
900501169
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$139.55 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$154.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$529.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$248.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$501.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$273.87
|
| Rate for Payer: Dignity Health Senior |
$248.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$248.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$521.97
|
| Rate for Payer: Heritage Provider Network Senior |
$521.97
|
| Rate for Payer: Humana Medicare |
$248.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$248.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$371.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$313.70
|
| Rate for Payer: Multiplan Commercial |
$578.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$279.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$257.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Vantage Medical Group Senior |
$248.97
|
|
|
HC I & D COMPL POST-OP WND INF
|
Facility
|
IP
|
$983.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
900501007
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$177.92 |
| Max. Negotiated Rate |
$737.25 |
| Rate for Payer: Adventist Health Commercial |
$196.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$675.32
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$665.49
|
| Rate for Payer: Heritage Provider Network Senior |
$665.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.75
|
| Rate for Payer: Multiplan Commercial |
$737.25
|
|
|
HC I & D COMPL POST-OP WND INF
|
Facility
|
OP
|
$983.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
900501007
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$177.92 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$196.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$675.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$638.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: Dignity Health Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,550.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$665.49
|
| Rate for Payer: Heritage Provider Network Senior |
$665.49
|
| Rate for Payer: Humana Medicare |
$3,550.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,550.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$473.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,189.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,473.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,473.33
|
| Rate for Payer: Multiplan Commercial |
$737.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$356.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$328.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
HC I & D DEEP ABSCESS NECK/THORAX
|
Facility
|
OP
|
$4,583.00
|
|
|
Service Code
|
CPT 21501
|
| Hospital Charge Code |
900501670
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$829.52 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$916.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,148.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,062.35
|
| Rate for Payer: Cash Price |
$2,062.35
|
| Rate for Payer: Cash Price |
$2,062.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,978.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: Dignity Health Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,550.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,102.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,102.69
|
| Rate for Payer: Humana Medicare |
$3,550.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,550.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,209.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$829.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,189.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,145.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,473.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,473.33
|
| Rate for Payer: Multiplan Commercial |
$3,437.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,664.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,531.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
HC I & D DEEP ABSCESS NECK/THORAX
|
Facility
|
IP
|
$4,583.00
|
|
|
Service Code
|
CPT 21501
|
| Hospital Charge Code |
900501670
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$829.52 |
| Max. Negotiated Rate |
$3,437.25 |
| Rate for Payer: Adventist Health Commercial |
$916.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,148.52
|
| Rate for Payer: Cash Price |
$2,062.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,102.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,102.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$829.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,145.75
|
| Rate for Payer: Multiplan Commercial |
$3,437.25
|
|
|
HC I&D DENTOALVEOLAR ABSC/HEMAT
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
900501150
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.15 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Adventist Health Commercial |
$118.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$406.70
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$400.78
|
| Rate for Payer: Heritage Provider Network Senior |
$400.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.00
|
| Rate for Payer: Multiplan Commercial |
$444.00
|
|
|
HC I&D DENTOALVEOLAR ABSC/HEMAT
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
900501150
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.15 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$118.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$406.70
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$384.80
|
| 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 |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$400.78
|
| Rate for Payer: Heritage Provider Network Senior |
$400.78
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$285.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.00
|
| 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 |
$444.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$214.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$197.79
|
| 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 IDENTIFY SENTINEL NODE
|
Facility
|
IP
|
$2,422.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
909301345
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$438.38 |
| Max. Negotiated Rate |
$1,816.50 |
| Rate for Payer: Adventist Health Commercial |
$484.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,663.91
|
| Rate for Payer: Cash Price |
$1,089.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,639.69
|
| Rate for Payer: Heritage Provider Network Senior |
$1,639.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$605.50
|
| Rate for Payer: Multiplan Commercial |
$1,816.50
|
|
|
HC IDENTIFY SENTINEL NODE
|
Facility
|
OP
|
$2,422.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
909301345
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$438.38 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$484.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,663.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,089.90
|
| Rate for Payer: Cash Price |
$1,089.90
|
| Rate for Payer: Cash Price |
$1,089.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,574.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,499.22
|
| Rate for Payer: Heritage Provider Network Senior |
$633.84
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$605.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$1,816.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$566.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC IDENT OF ARTHROPOD
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 87168
|
| Hospital Charge Code |
900912431
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$35.73 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.73
|
| Rate for Payer: Blue Shield of California Commercial |
$33.32
|
| Rate for Payer: Blue Shield of California EPN |
$26.05
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$4.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.38
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Senior |
$4.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC IDENT OF ARTHROPOD
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
CPT 87168
|
| Hospital Charge Code |
900912431
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Adventist Health Commercial |
$33.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.10
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.41
|
| Rate for Payer: Heritage Provider Network Senior |
$114.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.25
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
|
|
HC IDENT OF PARASITES
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
900911657
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Adventist Health Commercial |
$33.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.10
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.41
|
| Rate for Payer: Heritage Provider Network Senior |
$114.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.25
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
|
|
HC IDENT OF PARASITES
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
900911657
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$35.73 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.73
|
| Rate for Payer: Blue Shield of California Commercial |
$33.32
|
| Rate for Payer: Blue Shield of California EPN |
$26.05
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: Dignity Health Senior |
$4.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$4.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.31
|
| Rate for Payer: TriValley Medical Group Senior |
$4.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Senior |
$4.31
|
|
|
HC I & D EXTERNAL AUDITORY CANAL
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
900501255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$110.23 |
| Max. Negotiated Rate |
$456.75 |
| Rate for Payer: Adventist Health Commercial |
$121.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$418.38
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$412.29
|
| Rate for Payer: Heritage Provider Network Senior |
$412.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.25
|
| Rate for Payer: Multiplan Commercial |
$456.75
|
|
|
HC I & D EXTERNAL AUDITORY CANAL
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
900501255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$110.23 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$121.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$418.38
|
| 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 |
$3,237.00
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$395.85
|
| 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 |
$395.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$412.29
|
| Rate for Payer: Heritage Provider Network Senior |
$412.29
|
| 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 |
$293.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.25
|
| 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 |
$456.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$221.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$203.47
|
| 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 I & D HEM SEROMA FL COLL
|
Facility
|
IP
|
$4,416.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$799.30 |
| Max. Negotiated Rate |
$3,312.00 |
| Rate for Payer: Adventist Health Commercial |
$883.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,033.79
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,989.63
|
| Rate for Payer: Heritage Provider Network Senior |
$2,989.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$799.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.00
|
| Rate for Payer: Multiplan Commercial |
$3,312.00
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
OP
|
$4,416.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$77.83 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$883.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,033.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,742.34
|
| Rate for Payer: Blue Shield of California EPN |
$2,592.19
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,870.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,733.50
|
| Rate for Payer: Heritage Provider Network Senior |
$2,733.50
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$77.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$799.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$3,312.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,228.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2,025.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
IP
|
$4,416.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$799.30 |
| Max. Negotiated Rate |
$3,312.00 |
| Rate for Payer: Adventist Health Commercial |
$883.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,033.79
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,989.63
|
| Rate for Payer: Heritage Provider Network Senior |
$2,989.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$799.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.00
|
| Rate for Payer: Multiplan Commercial |
$3,312.00
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
OP
|
$4,416.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.83 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$883.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,033.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,870.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,733.50
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.60
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$77.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$799.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$3,312.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,228.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2,228.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
OP
|
$4,416.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$799.30 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$883.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,033.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,870.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,989.63
|
| Rate for Payer: Heritage Provider Network Senior |
$2,989.63
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,128.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$799.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$3,312.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,603.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,475.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
