|
HC INCISION/DRAIN,UPPER ARM/ELBOW
|
Facility
|
IP
|
$4,583.00
|
|
|
Service Code
|
CPT 23930
|
| Hospital Charge Code |
900501316
|
|
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 INCISION FINGER TENDON EACH
|
Facility
|
OP
|
$3,653.00
|
|
|
Service Code
|
CPT 26455
|
| Hospital Charge Code |
900501536
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$661.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$730.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,509.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,374.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: Dignity Health Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,008.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,473.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2,473.08
|
| Rate for Payer: Humana Medicare |
$2,008.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,760.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$913.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,530.19
|
| Rate for Payer: Multiplan Commercial |
$2,739.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,326.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,220.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC INCISION FINGER TENDON EACH
|
Facility
|
IP
|
$3,653.00
|
|
|
Service Code
|
CPT 26455
|
| Hospital Charge Code |
900501536
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$661.19 |
| Max. Negotiated Rate |
$2,739.75 |
| Rate for Payer: Adventist Health Commercial |
$730.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,509.61
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,473.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2,473.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$913.25
|
| Rate for Payer: Multiplan Commercial |
$2,739.75
|
|
|
HC INCISION LINGUAL FRENUM
|
Facility
|
IP
|
$3,362.00
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
900501558
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$608.52 |
| Max. Negotiated Rate |
$2,521.50 |
| Rate for Payer: Adventist Health Commercial |
$672.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,309.69
|
| Rate for Payer: Cash Price |
$1,512.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,276.07
|
| Rate for Payer: Heritage Provider Network Senior |
$2,276.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$608.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.50
|
| Rate for Payer: Multiplan Commercial |
$2,521.50
|
|
|
HC INCISION LINGUAL FRENUM
|
Facility
|
OP
|
$3,362.00
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
900501558
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$608.52 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$672.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,309.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,512.90
|
| Rate for Payer: Cash Price |
$1,512.90
|
| Rate for Payer: Cash Price |
$1,512.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,185.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: Dignity Health Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,905.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,276.07
|
| Rate for Payer: Heritage Provider Network Senior |
$2,276.07
|
| Rate for Payer: Humana Medicare |
$1,905.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,620.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$608.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,248.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,400.85
|
| Rate for Payer: Multiplan Commercial |
$2,521.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,220.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,123.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC INCISION OF EYE
|
Facility
|
OP
|
$6,375.00
|
|
|
Service Code
|
CPT 66172
|
| Hospital Charge Code |
900501631
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$7,436.00 |
| Rate for Payer: Adventist Health Commercial |
$1,275.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,379.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Cash Price |
$2,868.75
|
| Rate for Payer: Cash Price |
$2,868.75
|
| Rate for Payer: Cash Price |
$2,868.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,143.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: Dignity Health Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,143.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,911.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,315.88
|
| Rate for Payer: Heritage Provider Network Senior |
$4,315.88
|
| Rate for Payer: Humana Medicare |
$2,911.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,072.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,153.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,435.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,593.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,668.65
|
| Rate for Payer: Multiplan Commercial |
$4,781.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,314.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,129.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC INCISION OF EYE
|
Facility
|
IP
|
$6,375.00
|
|
|
Service Code
|
CPT 66172
|
| Hospital Charge Code |
900501631
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,153.88 |
| Max. Negotiated Rate |
$4,781.25 |
| Rate for Payer: Adventist Health Commercial |
$1,275.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,379.62
|
| Rate for Payer: Cash Price |
$2,868.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,315.88
|
| Rate for Payer: Heritage Provider Network Senior |
$4,315.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,153.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,593.75
|
| Rate for Payer: Multiplan Commercial |
$4,781.25
|
|
|
HC INCISION OF LABIAL FRENUM
|
Facility
|
IP
|
$679.00
|
|
|
Service Code
|
CPT 40806
|
| Hospital Charge Code |
900501559
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.90 |
| Max. Negotiated Rate |
$509.25 |
| Rate for Payer: Adventist Health Commercial |
$135.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$466.47
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$459.68
|
| Rate for Payer: Heritage Provider Network Senior |
$459.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.75
|
| Rate for Payer: Multiplan Commercial |
$509.25
|
|
|
HC INCISION OF LABIAL FRENUM
|
Facility
|
OP
|
$679.00
|
|
|
Service Code
|
CPT 40806
|
| Hospital Charge Code |
900501559
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.90 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$135.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$466.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$441.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: Dignity Health Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$687.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$459.68
|
| Rate for Payer: Heritage Provider Network Senior |
$459.68
|
| Rate for Payer: Humana Medicare |
$687.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$327.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$811.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$866.17
|
| Rate for Payer: Multiplan Commercial |
$509.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$246.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$226.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
OP
|
$1,099.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.92 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$219.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$755.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$494.55
|
| Rate for Payer: Cash Price |
$494.55
|
| Rate for Payer: Cash Price |
$494.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$714.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: Dignity Health Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$308.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.02
|
| Rate for Payer: Heritage Provider Network Senior |
$744.02
|
| Rate for Payer: Humana Medicare |
$308.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$529.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$364.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.08
|
| Rate for Payer: Multiplan Commercial |
$824.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$399.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$367.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
OP
|
$1,099.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$198.92 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$219.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$755.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$682.48
|
| Rate for Payer: Blue Shield of California EPN |
$645.11
|
| Rate for Payer: Cash Price |
$494.55
|
| Rate for Payer: Cash Price |
$494.55
|
| Rate for Payer: Cash Price |
$494.55
|
| Rate for Payer: Cash Price |
$494.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$714.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: Dignity Health Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$308.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$680.28
|
| Rate for Payer: Heritage Provider Network Senior |
$680.28
|
| Rate for Payer: Humana Medicare |
$308.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$297.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$586.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$364.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.08
|
| Rate for Payer: Multiplan Commercial |
$824.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$339.67
|
| Rate for Payer: TriValley Medical Group Senior |
$308.79
|
| 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 |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
IP
|
$1,099.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$198.92 |
| Max. Negotiated Rate |
$824.25 |
| Rate for Payer: Adventist Health Commercial |
$219.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$755.01
|
| Rate for Payer: Cash Price |
$494.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.02
|
| Rate for Payer: Heritage Provider Network Senior |
$744.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.75
|
| Rate for Payer: Multiplan Commercial |
$824.25
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
IP
|
$1,099.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.92 |
| Max. Negotiated Rate |
$824.25 |
| Rate for Payer: Adventist Health Commercial |
$219.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$755.01
|
| Rate for Payer: Cash Price |
$494.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.02
|
| Rate for Payer: Heritage Provider Network Senior |
$744.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.75
|
| Rate for Payer: Multiplan Commercial |
$824.25
|
|
|
HC INC & REM F/B SUBQ TIS COMPL
|
Facility
|
OP
|
$4,030.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
900501004
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$729.43 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$806.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,768.61
|
| 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 |
$1,813.50
|
| Rate for Payer: Cash Price |
$1,813.50
|
| Rate for Payer: Cash Price |
$1,813.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,619.50
|
| 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 |
$2,728.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2,728.31
|
| 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 |
$1,942.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,007.50
|
| 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 |
$3,022.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,463.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,346.42
|
| 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 INC & REM F/B SUBQ TIS COMPL
|
Facility
|
IP
|
$4,030.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
900501004
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$729.43 |
| Max. Negotiated Rate |
$3,022.50 |
| Rate for Payer: Adventist Health Commercial |
$806.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,768.61
|
| Rate for Payer: Cash Price |
$1,813.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,728.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2,728.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,007.50
|
| Rate for Payer: Multiplan Commercial |
$3,022.50
|
|
|
HC INC & REM FB SUBQ TISSUE
|
Facility
|
IP
|
$1,099.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
900501003
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.92 |
| Max. Negotiated Rate |
$824.25 |
| Rate for Payer: Adventist Health Commercial |
$219.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$755.01
|
| Rate for Payer: Cash Price |
$494.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.02
|
| Rate for Payer: Heritage Provider Network Senior |
$744.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.75
|
| Rate for Payer: Multiplan Commercial |
$824.25
|
|
|
HC INC & REM FB SUBQ TISSUE
|
Facility
|
OP
|
$1,099.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
900501003
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.92 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$219.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$755.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$494.55
|
| Rate for Payer: Cash Price |
$494.55
|
| Rate for Payer: Cash Price |
$494.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$714.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.02
|
| Rate for Payer: Heritage Provider Network Senior |
$744.02
|
| Rate for Payer: Humana Medicare |
$498.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$529.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$824.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$399.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$367.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC INCSNAL BX SKIN EA SEP/ADD LSN
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
900511107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.55 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$86.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$298.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$368.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$238.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.50
|
| 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 |
$195.30
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$282.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$368.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$368.90
|
| Rate for Payer: Dignity Health Senior |
$368.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.65
|
| Rate for Payer: Heritage Provider Network Senior |
$268.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$104.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$209.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.50
|
| Rate for Payer: Multiplan Commercial |
$325.50
|
| 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 Medi-Cal |
$368.90
|
| Rate for Payer: Vantage Medical Group Senior |
$368.90
|
|
|
HC INCSNAL BX SKIN EA SEP/ADD LSN
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
900511107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.55 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: Adventist Health Commercial |
$86.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$298.16
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$293.82
|
| Rate for Payer: Heritage Provider Network Senior |
$293.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.50
|
| Rate for Payer: Multiplan Commercial |
$325.50
|
|
|
HC INDR MICROPUNCTURE NEEDLE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081252
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$93.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Blue Shield of California Commercial |
$74.52
|
| Rate for Payer: Blue Shield of California EPN |
$70.44
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Senior |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.28
|
| Rate for Payer: Heritage Provider Network Senior |
$74.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$57.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC INDR MICROPUNCTURE NEEDLE
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081252
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.44
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.24
|
| Rate for Payer: Heritage Provider Network Senior |
$81.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
|
|
HC INFANT LOWER EXT 2 VIEW
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
909001630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$533.25 |
| Rate for Payer: Adventist Health Commercial |
$142.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$488.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.11
|
| Rate for Payer: Blue Shield of California Commercial |
$98.89
|
| Rate for Payer: Blue Shield of California EPN |
$56.23
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$462.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$462.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$440.11
|
| Rate for Payer: Heritage Provider Network Senior |
$440.11
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$533.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC INFANT LOWER EXT 2 VIEW
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
909001630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$128.69 |
| Max. Negotiated Rate |
$533.25 |
| Rate for Payer: Adventist Health Commercial |
$142.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$488.46
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$481.35
|
| Rate for Payer: Heritage Provider Network Senior |
$481.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.75
|
| Rate for Payer: Multiplan Commercial |
$533.25
|
|
|
HC INFANT UPPER EXT 2 VIEW
|
Facility
|
IP
|
$607.00
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
909001555
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.87 |
| Max. Negotiated Rate |
$455.25 |
| Rate for Payer: Adventist Health Commercial |
$121.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$417.01
|
| Rate for Payer: Cash Price |
$273.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.94
|
| Rate for Payer: Heritage Provider Network Senior |
$410.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.75
|
| Rate for Payer: Multiplan Commercial |
$455.25
|
|
|
HC INFANT UPPER EXT 2 VIEW
|
Facility
|
OP
|
$607.00
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
909001555
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$455.25 |
| Rate for Payer: Adventist Health Commercial |
$121.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$417.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.11
|
| Rate for Payer: Blue Shield of California Commercial |
$98.89
|
| Rate for Payer: Blue Shield of California EPN |
$56.23
|
| Rate for Payer: Cash Price |
$273.15
|
| Rate for Payer: Cash Price |
$273.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$394.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$394.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.73
|
| Rate for Payer: Heritage Provider Network Senior |
$375.73
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$455.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
