|
HC DEMO/EVAL PT UTILIZATN INHALER
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
900800112
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$20.27 |
| Max. Negotiated Rate |
$422.46 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$72.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$422.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$309.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$281.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$281.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.33
|
| Rate for Payer: Heritage Provider Network Senior |
$69.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$281.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$53.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$323.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$377.40
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Vantage Medical Group Senior |
$281.64
|
|
|
HC DEMO/EVAL PT UTILIZATN INHALER
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
900800112
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$20.27 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.13
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$75.82
|
| Rate for Payer: Heritage Provider Network Senior |
$75.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
|
|
HC DENTAL IMPLANT/NOBLEGUIDE
|
Facility
|
OP
|
$702.00
|
|
| Hospital Charge Code |
909201006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$127.06 |
| Max. Negotiated Rate |
$910.00 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$433.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$526.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$351.14
|
| Rate for Payer: Blue Shield of California Commercial |
$428.22
|
| Rate for Payer: Blue Shield of California EPN |
$342.58
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$596.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$596.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$334.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$491.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$351.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$351.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.70
|
| Rate for Payer: Vantage Medical Group Senior |
$596.70
|
|
|
HC DENTAL IMPLANT/NOBLEGUIDE
|
Facility
|
IP
|
$702.00
|
|
| Hospital Charge Code |
909201006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$127.06 |
| Max. Negotiated Rate |
$711.00 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$452.09
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$475.25
|
| Rate for Payer: Heritage Provider Network Senior |
$475.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.50
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
|
|
HC DERMABOND
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
909081731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.52
|
| Rate for Payer: Blue Shield of California Commercial |
$48.19
|
| Rate for Payer: Blue Shield of California EPN |
$38.55
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.90
|
| Rate for Payer: Heritage Provider Network Senior |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$37.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55.30
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$39.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$39.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.15
|
| Rate for Payer: Vantage Medical Group Senior |
$67.15
|
|
|
HC DERMABOND
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
909081731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.88
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.48
|
| Rate for Payer: Heritage Provider Network Senior |
$53.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
|
|
HC DERMATOPHAGOIDES MICROCERAS IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913636
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$150.09 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.09
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.85
|
| Rate for Payer: Heritage Provider Network Senior |
$40.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$31.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC DERMATOPHAGOIDES MICROCERAS IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913636
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.50
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.68
|
| Rate for Payer: Heritage Provider Network Senior |
$44.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
|
|
HC DESCENDING THORACIC AORTOGRAM
|
Facility
|
IP
|
$7,293.00
|
|
|
Service Code
|
CPT 75600
|
| Hospital Charge Code |
906811497
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,320.03 |
| Max. Negotiated Rate |
$5,469.75 |
| Rate for Payer: Adventist Health Commercial |
$1,458.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,696.69
|
| Rate for Payer: Cash Price |
$3,281.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,937.36
|
| Rate for Payer: Heritage Provider Network Senior |
$4,937.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,320.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,823.25
|
| Rate for Payer: Multiplan Commercial |
$5,469.75
|
|
|
HC DESCENDING THORACIC AORTOGRAM
|
Facility
|
OP
|
$7,293.00
|
|
|
Service Code
|
CPT 75600
|
| Hospital Charge Code |
906811497
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,320.03 |
| Max. Negotiated Rate |
$6,091.57 |
| Rate for Payer: Cash Price |
$3,281.85
|
| Rate for Payer: Cash Price |
$3,281.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,740.45
|
| Rate for Payer: Adventist Health Commercial |
$1,458.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,507.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,422.90
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,302.87
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,514.37
|
| Rate for Payer: Heritage Provider Network Senior |
$4,514.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,478.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,320.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,823.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$5,469.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,061.05
|
| Rate for Payer: TriValley Medical Group Senior |
$4,061.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC DEST BENIGN/PREMAL 1ST LESION
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
900501417
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$142.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$109.25
|
| Rate for Payer: Blue Shield of California EPN |
$86.94
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$149.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.71
|
| Rate for Payer: Heritage Provider Network Senior |
$155.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$109.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Senior |
$138.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC DEST BENIGN/PREMAL 1ST LESION
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
900501417
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.63 |
| Max. Negotiated Rate |
$172.50 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$148.12
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.71
|
| Rate for Payer: Heritage Provider Network Senior |
$155.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.50
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
|
|
HC DEST FLAT WARTS UP TO 14 LESIONS
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
900501049
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$56.11 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$62.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$191.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$147.25
|
| Rate for Payer: Blue Shield of California EPN |
$117.18
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$201.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$209.87
|
| Rate for Payer: Heritage Provider Network Senior |
$209.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$147.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$232.50
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$186.00
|
| Rate for Payer: TriValley Medical Group Senior |
$186.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC DEST FLAT WARTS UP TO 14 LESIONS
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
900501049
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$56.11 |
| Max. Negotiated Rate |
$232.50 |
| Rate for Payer: Adventist Health Commercial |
$62.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$199.64
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$209.87
|
| Rate for Payer: Heritage Provider Network Senior |
$209.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.50
|
| Rate for Payer: Multiplan Commercial |
$232.50
|
|
|
HC DEST MALGNANT LESION LT 0.5 CM
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
900501361
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.35 |
| Max. Negotiated Rate |
$349.50 |
| Rate for Payer: Adventist Health Commercial |
$93.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$300.10
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.48
|
| Rate for Payer: Heritage Provider Network Senior |
$315.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.50
|
| Rate for Payer: Multiplan Commercial |
$349.50
|
|
|
HC DEST MALGNANT LESION LT 0.5 CM
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
900501361
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$93.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$287.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$221.35
|
| Rate for Payer: Blue Shield of California EPN |
$176.15
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$302.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.48
|
| Rate for Payer: Heritage Provider Network Senior |
$315.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$222.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$349.50
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$279.60
|
| Rate for Payer: TriValley Medical Group Senior |
$279.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC DEST OF LESIONS LT 10 SQ CM
|
Facility
|
IP
|
$670.00
|
|
|
Service Code
|
CPT 17106
|
| Hospital Charge Code |
900501553
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.27 |
| Max. Negotiated Rate |
$502.50 |
| Rate for Payer: Adventist Health Commercial |
$134.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$431.48
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$453.59
|
| Rate for Payer: Heritage Provider Network Senior |
$453.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$121.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.50
|
| Rate for Payer: Multiplan Commercial |
$502.50
|
|
|
HC DEST OF LESIONS LT 10 SQ CM
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
CPT 17106
|
| Hospital Charge Code |
900501553
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.27 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$134.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$414.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$318.25
|
| Rate for Payer: Blue Shield of California EPN |
$253.26
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$435.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$453.59
|
| Rate for Payer: Heritage Provider Network Senior |
$453.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$319.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$121.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$502.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$402.00
|
| Rate for Payer: TriValley Medical Group Senior |
$402.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC DESTUCT BY NEURO AGENT
|
Facility
|
OP
|
$2,601.00
|
|
|
Service Code
|
CPT 64630
|
| Hospital Charge Code |
950442347
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$470.78 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$520.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,607.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$1,170.45
|
| Rate for Payer: Cash Price |
$1,170.45
|
| Rate for Payer: Cash Price |
$1,170.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,690.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,137.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,610.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,399.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,161.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$470.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,308.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$650.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$1,950.75
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,251.34
|
| Rate for Payer: TriValley Medical Group Senior |
$1,251.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC DESTUCT BY NEURO AGENT
|
Facility
|
IP
|
$2,601.00
|
|
|
Service Code
|
CPT 64630
|
| Hospital Charge Code |
950442347
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$470.78 |
| Max. Negotiated Rate |
$1,950.75 |
| Rate for Payer: Adventist Health Commercial |
$520.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,675.04
|
| Rate for Payer: Cash Price |
$1,170.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,760.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,760.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$470.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$650.25
|
| Rate for Payer: Multiplan Commercial |
$1,950.75
|
|
|
HC DETERMINATION/VENOUS PRESSURE
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT 93770
|
| Hospital Charge Code |
900501622
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.85 |
| Max. Negotiated Rate |
$1,992.00 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$180.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$138.70
|
| Rate for Payer: Blue Shield of California EPN |
$110.38
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$189.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$248.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$197.68
|
| Rate for Payer: Heritage Provider Network Senior |
$197.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$139.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$204.40
|
| Rate for Payer: Multiplan Commercial |
$219.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.20
|
| Rate for Payer: TriValley Medical Group Senior |
$175.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.20
|
| Rate for Payer: Vantage Medical Group Senior |
$248.20
|
|
|
HC DETERMINATION/VENOUS PRESSURE
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT 93770
|
| Hospital Charge Code |
900501622
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.85 |
| Max. Negotiated Rate |
$219.00 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$188.05
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$197.68
|
| Rate for Payer: Heritage Provider Network Senior |
$197.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.00
|
| Rate for Payer: Multiplan Commercial |
$219.00
|
|
|
HC DEVELOPMENT COG SKILLS
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
905601806
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.26
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.76
|
| Rate for Payer: Heritage Provider Network Senior |
$71.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
|
|
HC DEVELOPMENT COG SKILLS
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
905103360
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Adventist Health Commercial |
$35.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$113.34
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$119.15
|
| Rate for Payer: Heritage Provider Network Senior |
$119.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
|
|
HC DEVELOPMENT COG SKILLS
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
905104360
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$43.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$68.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.61
|
| Rate for Payer: Heritage Provider Network Senior |
$65.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$50.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$74.20
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.10
|
| Rate for Payer: Vantage Medical Group Senior |
$90.10
|
|
