|
HC EXCISION OF GUM LESION
|
Facility
|
IP
|
$3,912.00
|
|
|
Service Code
|
CPT 41825
|
| Hospital Charge Code |
900501744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$708.07 |
| Max. Negotiated Rate |
$2,934.00 |
| Rate for Payer: Adventist Health Commercial |
$782.40
|
| Rate for Payer: Cash Price |
$2,151.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,648.42
|
| Rate for Payer: Heritage Provider Network Senior |
$2,648.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$708.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.00
|
| Rate for Payer: Multiplan Commercial |
$2,934.00
|
|
|
HC EXCISION OF LINGUAL FRENUM
|
Facility
|
IP
|
$1,762.00
|
|
|
Service Code
|
CPT 41115
|
| Hospital Charge Code |
900501757
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$318.92 |
| Max. Negotiated Rate |
$1,321.50 |
| Rate for Payer: Adventist Health Commercial |
$352.40
|
| Rate for Payer: Cash Price |
$969.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,192.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,192.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.50
|
| Rate for Payer: Multiplan Commercial |
$1,321.50
|
|
|
HC EXCISION OF LINGUAL FRENUM
|
Facility
|
OP
|
$1,762.00
|
|
|
Service Code
|
CPT 41115
|
| Hospital Charge Code |
900501757
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$352.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,210.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$969.10
|
| Rate for Payer: Cash Price |
$969.10
|
| Rate for Payer: Cash Price |
$969.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,145.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Senior |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,882.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,192.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,192.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$840.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,164.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,371.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,371.46
|
| Rate for Payer: Multiplan Commercial |
$1,321.50
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$633.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$583.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
HC EXCISION/REPAIR EYELID GT 1/4
|
Facility
|
OP
|
$4,628.00
|
|
|
Service Code
|
CPT 67966
|
| Hospital Charge Code |
900501712
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$6,004.00 |
| Rate for Payer: Adventist Health Commercial |
$925.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,179.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,964.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$2,545.40
|
| Rate for Payer: Cash Price |
$2,545.40
|
| Rate for Payer: Cash Price |
$2,545.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,008.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,260.69
|
| Rate for Payer: Dignity Health Senior |
$2,964.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,008.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,964.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,133.16
|
| Rate for Payer: Heritage Provider Network Senior |
$3,133.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,964.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,207.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$837.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,408.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,157.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,734.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,734.97
|
| Rate for Payer: Multiplan Commercial |
$3,471.00
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,665.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,532.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,964.26
|
|
|
HC EXCISION/REPAIR EYELID GT 1/4
|
Facility
|
IP
|
$4,628.00
|
|
|
Service Code
|
CPT 67966
|
| Hospital Charge Code |
900501712
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$837.67 |
| Max. Negotiated Rate |
$3,471.00 |
| Rate for Payer: Adventist Health Commercial |
$925.60
|
| Rate for Payer: Cash Price |
$2,545.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,133.16
|
| Rate for Payer: Heritage Provider Network Senior |
$3,133.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$837.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,157.00
|
| Rate for Payer: Multiplan Commercial |
$3,471.00
|
|
|
HC EXCISION TONGUE LESION W/O CLOSURE
|
Facility
|
IP
|
$3,885.00
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
900501147
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$703.18 |
| Max. Negotiated Rate |
$2,913.75 |
| Rate for Payer: Adventist Health Commercial |
$777.00
|
| Rate for Payer: Cash Price |
$2,136.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,630.14
|
| Rate for Payer: Heritage Provider Network Senior |
$2,630.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$703.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$971.25
|
| Rate for Payer: Multiplan Commercial |
$2,913.75
|
|
|
HC EXCISION TONGUE LESION W/O CLOSURE
|
Facility
|
OP
|
$3,885.00
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
900501147
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$777.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,668.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$2,136.75
|
| Rate for Payer: Cash Price |
$2,136.75
|
| Rate for Payer: Cash Price |
$2,136.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,525.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Senior |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,120.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,630.14
|
| Rate for Payer: Heritage Provider Network Senior |
$2,630.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,853.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$703.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,738.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$971.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,192.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,192.01
|
| Rate for Payer: Multiplan Commercial |
$2,913.75
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,397.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,286.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC EXCSN EXT THROMBOTC HEMORRHOID
|
Facility
|
IP
|
$5,446.00
|
|
|
Service Code
|
CPT 46320
|
| Hospital Charge Code |
900501158
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$985.73 |
| Max. Negotiated Rate |
$4,084.50 |
| Rate for Payer: Adventist Health Commercial |
$1,089.20
|
| Rate for Payer: Cash Price |
$2,995.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,686.94
|
| Rate for Payer: Heritage Provider Network Senior |
$3,686.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$985.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,361.50
|
| Rate for Payer: Multiplan Commercial |
$4,084.50
|
|
|
HC EXCSN EXT THROMBOTC HEMORRHOID
|
Facility
|
OP
|
$5,446.00
|
|
|
Service Code
|
CPT 46320
|
| Hospital Charge Code |
900501158
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,089.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,741.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$2,995.30
|
| Rate for Payer: Cash Price |
$2,995.30
|
| Rate for Payer: Cash Price |
$2,995.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,539.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Senior |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,498.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,686.94
|
| Rate for Payer: Heritage Provider Network Senior |
$3,686.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,597.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$985.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,361.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,887.66
|
| Rate for Payer: Multiplan Commercial |
$4,084.50
|
| Rate for Payer: Multiplan WC |
$2,387.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,959.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,803.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC EXC TST BRNCHSPSM WO EC RCRDG
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 94619
|
| Hospital Charge Code |
900894619
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$28.78 |
| Max. Negotiated Rate |
$119.25 |
| Rate for Payer: Adventist Health Commercial |
$31.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$84.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$109.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Blue Shield of California Commercial |
$96.99
|
| Rate for Payer: Blue Shield of California EPN |
$77.59
|
| Rate for Payer: Cash Price |
$87.45
|
| Rate for Payer: Cash Price |
$87.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$103.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Senior |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$98.42
|
| Rate for Payer: Heritage Provider Network Senior |
$98.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$107.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$75.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.09
|
| Rate for Payer: Multiplan Commercial |
$119.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$83.02
|
| Rate for Payer: TriValley Medical Group Senior |
$75.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$79.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$79.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC EXC TST BRNCHSPSM WO EC RCRDG
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT 94619
|
| Hospital Charge Code |
900894619
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$28.78 |
| Max. Negotiated Rate |
$119.25 |
| Rate for Payer: Adventist Health Commercial |
$31.80
|
| Rate for Payer: Cash Price |
$87.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.64
|
| Rate for Payer: Heritage Provider Network Senior |
$107.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.75
|
| Rate for Payer: Multiplan Commercial |
$119.25
|
|
|
HC EXERCISE TEST BRONCHOSPASM
|
Facility
|
OP
|
$303.00
|
|
|
Service Code
|
CPT 94617
|
| Hospital Charge Code |
900894620
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$245.67 |
| Rate for Payer: Adventist Health Commercial |
$60.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$161.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$208.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Blue Shield of California Commercial |
$184.83
|
| Rate for Payer: Blue Shield of California EPN |
$147.86
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$196.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Senior |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$187.56
|
| Rate for Payer: Heritage Provider Network Senior |
$187.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$140.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$144.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.36
|
| Rate for Payer: Multiplan Commercial |
$227.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$180.16
|
| Rate for Payer: TriValley Medical Group Senior |
$163.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$151.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$151.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC EXERCISE TEST BRONCHOSPASM
|
Facility
|
IP
|
$303.00
|
|
|
Service Code
|
CPT 94617
|
| Hospital Charge Code |
900894620
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$227.25 |
| Rate for Payer: Adventist Health Commercial |
$60.60
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.13
|
| Rate for Payer: Heritage Provider Network Senior |
$205.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.75
|
| Rate for Payer: Multiplan Commercial |
$227.25
|
|
|
HC EX FOR SPEECH DEVICE RX ADDL
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
905601817
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$163.50 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.59
|
| Rate for Payer: Heritage Provider Network Senior |
$147.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
|
|
HC EX FOR SPEECH DEVICE RX ADDL
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
905601817
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$89.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$116.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$119.90
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$141.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.30
|
| Rate for Payer: Dignity Health Senior |
$185.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.94
|
| Rate for Payer: Heritage Provider Network Senior |
$134.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$103.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.60
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| 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 |
$185.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.30
|
| Rate for Payer: Vantage Medical Group Senior |
$185.30
|
|
|
HC EX OF NAIL & MAT PART OR COMP
|
Facility
|
OP
|
$1,239.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
900501017
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$247.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$851.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$681.45
|
| Rate for Payer: Cash Price |
$681.45
|
| Rate for Payer: Cash Price |
$681.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$805.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Senior |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$838.80
|
| Rate for Payer: Heritage Provider Network Senior |
$838.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$591.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$224.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$309.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$639.63
|
| Rate for Payer: Multiplan Commercial |
$929.25
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$445.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$410.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC EX OF NAIL & MAT PART OR COMP
|
Facility
|
IP
|
$1,239.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
900501017
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.26 |
| Max. Negotiated Rate |
$929.25 |
| Rate for Payer: Adventist Health Commercial |
$247.80
|
| Rate for Payer: Cash Price |
$681.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$838.80
|
| Rate for Payer: Heritage Provider Network Senior |
$838.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$224.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$309.75
|
| Rate for Payer: Multiplan Commercial |
$929.25
|
|
|
HC EXPIRED CARBON DIOXIDE DETERM
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 94770
|
| Hospital Charge Code |
900800104
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$89.23 |
| Max. Negotiated Rate |
$419.05 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$263.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$338.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$419.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$369.75
|
| Rate for Payer: Blue Shield of California Commercial |
$300.73
|
| Rate for Payer: Blue Shield of California EPN |
$240.58
|
| Rate for Payer: Cash Price |
$271.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$320.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$419.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$419.05
|
| Rate for Payer: Dignity Health Senior |
$419.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$320.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$305.17
|
| Rate for Payer: Heritage Provider Network Senior |
$305.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$235.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$345.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.10
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$246.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$246.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$419.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$419.05
|
| Rate for Payer: Vantage Medical Group Senior |
$419.05
|
|
|
HC EXPIRED CARBON DIOXIDE DETERM
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 94770
|
| Hospital Charge Code |
900800104
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$89.23 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Cash Price |
$271.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$333.76
|
| Rate for Payer: Heritage Provider Network Senior |
$333.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.25
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
|
|
HC EXPIRED CO2 DETERM
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800910
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$61.72 |
| Max. Negotiated Rate |
$298.20 |
| Rate for Payer: Adventist Health Commercial |
$68.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$182.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$234.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Blue Shield of California Commercial |
$208.01
|
| Rate for Payer: Blue Shield of California EPN |
$166.41
|
| Rate for Payer: Cash Price |
$187.55
|
| Rate for Payer: Cash Price |
$187.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$221.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Senior |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$198.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$211.08
|
| Rate for Payer: Heritage Provider Network Senior |
$211.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$162.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.49
|
| Rate for Payer: Multiplan Commercial |
$255.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$218.68
|
| Rate for Payer: TriValley Medical Group Senior |
$198.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$170.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$170.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC EXPIRED CO2 DETERM
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800910
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$61.72 |
| Max. Negotiated Rate |
$255.75 |
| Rate for Payer: Adventist Health Commercial |
$68.20
|
| Rate for Payer: Cash Price |
$187.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$230.86
|
| Rate for Payer: Heritage Provider Network Senior |
$230.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.25
|
| Rate for Payer: Multiplan Commercial |
$255.75
|
|
|
HC EXPLORATION OF NECK WOUND
|
Facility
|
IP
|
$1,666.00
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
900501384
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.55 |
| Max. Negotiated Rate |
$1,249.50 |
| Rate for Payer: Adventist Health Commercial |
$333.20
|
| Rate for Payer: Cash Price |
$916.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,127.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,127.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$416.50
|
| Rate for Payer: Multiplan Commercial |
$1,249.50
|
|
|
HC EXPLORATION OF NECK WOUND
|
Facility
|
OP
|
$1,666.00
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
900501384
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.55 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$333.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$890.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,144.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$916.30
|
| Rate for Payer: Cash Price |
$916.30
|
| Rate for Payer: Cash Price |
$916.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,082.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Senior |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$647.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,127.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,127.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$794.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$744.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$416.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$815.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$815.28
|
| Rate for Payer: Multiplan Commercial |
$1,249.50
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$599.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$551.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC EXPLORE KNEE I & D W/F.B. RMVL
|
Facility
|
OP
|
$7,359.00
|
|
|
Service Code
|
CPT 27310
|
| Hospital Charge Code |
900501671
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,471.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,055.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Cash Price |
$4,047.45
|
| Rate for Payer: Cash Price |
$4,047.45
|
| Rate for Payer: Cash Price |
$4,047.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,783.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Senior |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,122.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,982.04
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,510.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,331.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,740.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,839.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,194.48
|
| Rate for Payer: Multiplan Commercial |
$5,519.25
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,647.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,436.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC EXPLORE KNEE I & D W/F.B. RMVL
|
Facility
|
IP
|
$7,359.00
|
|
|
Service Code
|
CPT 27310
|
| Hospital Charge Code |
900501671
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,331.98 |
| Max. Negotiated Rate |
$5,519.25 |
| Rate for Payer: Adventist Health Commercial |
$1,471.80
|
| Rate for Payer: Cash Price |
$4,047.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,982.04
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,331.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,839.75
|
| Rate for Payer: Multiplan Commercial |
$5,519.25
|
|
