|
HC EXTERNAL VERSION
|
Facility
|
IP
|
$8,848.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
902400105
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,601.49 |
| Max. Negotiated Rate |
$6,636.00 |
| Rate for Payer: Adventist Health Commercial |
$1,769.60
|
| Rate for Payer: Cash Price |
$4,866.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,990.10
|
| Rate for Payer: Heritage Provider Network Senior |
$5,990.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,601.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,212.00
|
| Rate for Payer: Multiplan Commercial |
$6,636.00
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBMANDI
|
Facility
|
OP
|
$3,810.00
|
|
|
Service Code
|
CPT 41017
|
| Hospital Charge Code |
900501410
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$762.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,617.47
|
| 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 |
$2,095.50
|
| Rate for Payer: Cash Price |
$2,095.50
|
| Rate for Payer: Cash Price |
$2,095.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,476.50
|
| 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 |
$2,579.37
|
| Rate for Payer: Heritage Provider Network Senior |
$2,579.37
|
| 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 |
$1,817.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$689.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,738.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$952.50
|
| 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 |
$2,857.50
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,370.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,261.49
|
| 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 EXTRAORAL I&D ABSCESS,SUBMANDI
|
Facility
|
IP
|
$3,810.00
|
|
|
Service Code
|
CPT 41017
|
| Hospital Charge Code |
900501410
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$689.61 |
| Max. Negotiated Rate |
$2,857.50 |
| Rate for Payer: Adventist Health Commercial |
$762.00
|
| Rate for Payer: Cash Price |
$2,095.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,579.37
|
| Rate for Payer: Heritage Provider Network Senior |
$2,579.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$689.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$952.50
|
| Rate for Payer: Multiplan Commercial |
$2,857.50
|
|
|
HC EXTREMITY STUDY COMPLEX
|
Facility
|
IP
|
$1,509.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
908100119
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$273.13 |
| Max. Negotiated Rate |
$1,131.75 |
| Rate for Payer: Adventist Health Commercial |
$301.80
|
| Rate for Payer: Cash Price |
$829.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,021.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1,021.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.25
|
| Rate for Payer: Multiplan Commercial |
$1,131.75
|
|
|
HC EXTREMITY STUDY COMPLEX
|
Facility
|
OP
|
$1,509.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
908100119
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$157.72 |
| Max. Negotiated Rate |
$1,131.75 |
| Rate for Payer: Adventist Health Commercial |
$301.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$806.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,036.68
|
| 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 |
$607.49
|
| Rate for Payer: Blue Shield of California EPN |
$488.52
|
| Rate for Payer: Cash Price |
$829.95
|
| Rate for Payer: Cash Price |
$829.95
|
| Rate for Payer: Cash Price |
$829.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$980.85
|
| 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 |
$980.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$198.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$934.07
|
| Rate for Payer: Heritage Provider Network Senior |
$934.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$157.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$719.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.25
|
| 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 |
$1,131.75
|
| 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 |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| 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 EXTREMITY STUDY SIMPLE
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
900803200
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$1,077.00 |
| Rate for Payer: Adventist Health Commercial |
$179.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$479.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$616.93
|
| 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 |
$390.48
|
| Rate for Payer: Blue Shield of California EPN |
$314.01
|
| Rate for Payer: Cash Price |
$493.90
|
| Rate for Payer: Cash Price |
$493.90
|
| Rate for Payer: Cash Price |
$493.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$583.70
|
| 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 |
$583.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$555.86
|
| Rate for Payer: Heritage Provider Network Senior |
$555.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$84.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$428.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.50
|
| 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 |
$673.50
|
| 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 |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| 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 EXTREMITY STUDY SIMPLE
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
900803200
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$162.54 |
| Max. Negotiated Rate |
$673.50 |
| Rate for Payer: Adventist Health Commercial |
$179.60
|
| Rate for Payer: Cash Price |
$493.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$607.95
|
| Rate for Payer: Heritage Provider Network Senior |
$607.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.50
|
| Rate for Payer: Multiplan Commercial |
$673.50
|
|
|
HC EYE EXAM & TREAT W/CON SED LTD
|
Facility
|
OP
|
$3,864.00
|
|
|
Service Code
|
CPT 92019
|
| Hospital Charge Code |
900501662
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$699.38 |
| Max. Negotiated Rate |
$4,723.01 |
| Rate for Payer: Adventist Health Commercial |
$772.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,065.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,654.57
|
| 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 |
$3,531.00
|
| Rate for Payer: Cash Price |
$2,125.20
|
| Rate for Payer: Cash Price |
$2,125.20
|
| Rate for Payer: Cash Price |
$2,125.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,511.60
|
| 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 |
$2,511.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,964.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,615.93
|
| Rate for Payer: Heritage Provider Network Senior |
$2,615.93
|
| 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 |
$1,843.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$699.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,408.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$966.00
|
| 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 |
$2,898.00
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,390.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,279.37
|
| 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 EYE EXAM & TREAT W/CON SED LTD
|
Facility
|
IP
|
$3,864.00
|
|
|
Service Code
|
CPT 92019
|
| Hospital Charge Code |
900501662
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$699.38 |
| Max. Negotiated Rate |
$2,898.00 |
| Rate for Payer: Adventist Health Commercial |
$772.80
|
| Rate for Payer: Cash Price |
$2,125.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,615.93
|
| Rate for Payer: Heritage Provider Network Senior |
$2,615.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$699.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$966.00
|
| Rate for Payer: Multiplan Commercial |
$2,898.00
|
|
|
HC EYE FOR FOREIGN BODY
|
Facility
|
IP
|
$736.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
909001113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$133.22 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Adventist Health Commercial |
$147.20
|
| Rate for Payer: Cash Price |
$404.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$498.27
|
| Rate for Payer: Heritage Provider Network Senior |
$498.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.00
|
| Rate for Payer: Multiplan Commercial |
$552.00
|
|
|
HC EYE FOR FOREIGN BODY
|
Facility
|
OP
|
$736.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
909001113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.98 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Adventist Health Commercial |
$147.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$393.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$505.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$85.73
|
| Rate for Payer: Blue Shield of California EPN |
$68.94
|
| Rate for Payer: Cash Price |
$404.80
|
| Rate for Payer: Cash Price |
$404.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$478.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$478.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$455.58
|
| Rate for Payer: Heritage Provider Network Senior |
$455.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$351.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$552.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| 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 |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC EYE PARACENTESIS W/RELEASE AQU
|
Facility
|
OP
|
$4,187.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
900501304
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4,617.28 |
| Rate for Payer: Adventist Health Commercial |
$837.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,876.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$2,302.85
|
| Rate for Payer: Cash Price |
$2,302.85
|
| Rate for Payer: Cash Price |
$2,302.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,721.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Senior |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,721.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,897.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,834.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2,834.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,997.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$757.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,332.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,046.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,651.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,651.35
|
| Rate for Payer: Multiplan Commercial |
$3,140.25
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,506.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,386.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC EYE PARACENTESIS W/RELEASE AQU
|
Facility
|
IP
|
$4,187.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
900501304
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$757.85 |
| Max. Negotiated Rate |
$3,140.25 |
| Rate for Payer: Adventist Health Commercial |
$837.40
|
| Rate for Payer: Cash Price |
$2,302.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,834.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2,834.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$757.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,046.75
|
| Rate for Payer: Multiplan Commercial |
$3,140.25
|
|
|
HC EYE PARACENTESIS W/RML VITREOU
|
Facility
|
IP
|
$6,288.00
|
|
|
Service Code
|
CPT 65810
|
| Hospital Charge Code |
900501528
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,138.13 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,257.60
|
| Rate for Payer: Cash Price |
$3,458.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,256.98
|
| Rate for Payer: Heritage Provider Network Senior |
$4,256.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,138.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,572.00
|
| Rate for Payer: Multiplan Commercial |
$4,716.00
|
|
|
HC EYE PARACENTESIS W/RML VITREOU
|
Facility
|
OP
|
$6,288.00
|
|
|
Service Code
|
CPT 65810
|
| Hospital Charge Code |
900501528
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$6,004.00 |
| Rate for Payer: Adventist Health Commercial |
$1,257.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,319.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$3,458.40
|
| Rate for Payer: Cash Price |
$3,458.40
|
| Rate for Payer: Cash Price |
$3,458.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,087.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Senior |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,087.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,897.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,256.98
|
| Rate for Payer: Heritage Provider Network Senior |
$4,256.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,999.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,138.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,332.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,572.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,651.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,651.35
|
| Rate for Payer: Multiplan Commercial |
$4,716.00
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,262.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,081.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC EYE SERVICE ORPROCEDURE
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 92499
|
| Hospital Charge Code |
900501542
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$31.12 |
| Max. Negotiated Rate |
$1,915.00 |
| Rate for Payer: Adventist Health Commercial |
$51.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$138.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$177.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$142.45
|
| Rate for Payer: Cash Price |
$142.45
|
| Rate for Payer: Cash Price |
$142.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$168.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Senior |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$31.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$175.34
|
| Rate for Payer: Heritage Provider Network Senior |
$175.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$123.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.21
|
| Rate for Payer: Multiplan Commercial |
$194.25
|
| Rate for Payer: Multiplan WC |
$49.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$93.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$85.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC EYE SERVICE ORPROCEDURE
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 92499
|
| Hospital Charge Code |
900501542
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$194.25 |
| Rate for Payer: Adventist Health Commercial |
$51.80
|
| Rate for Payer: Cash Price |
$142.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$175.34
|
| Rate for Payer: Heritage Provider Network Senior |
$175.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.75
|
| Rate for Payer: Multiplan Commercial |
$194.25
|
|
|
HC F18 FDG UP TO 45 MCI
|
Facility
|
IP
|
$1,449.00
|
|
|
Service Code
|
CPT A9552
|
| Hospital Charge Code |
909301499
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$262.27 |
| Max. Negotiated Rate |
$1,086.75 |
| Rate for Payer: Adventist Health Commercial |
$289.80
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$782.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$980.97
|
| Rate for Payer: Heritage Provider Network Senior |
$980.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.25
|
| Rate for Payer: Multiplan Commercial |
$1,086.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$523.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$479.76
|
|
|
HC F18 FDG UP TO 45 MCI
|
Facility
|
OP
|
$1,449.00
|
|
|
Service Code
|
CPT A9552
|
| Hospital Charge Code |
909301499
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$262.27 |
| Max. Negotiated Rate |
$1,231.65 |
| Rate for Payer: Adventist Health Commercial |
$289.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,231.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$796.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,086.75
|
| Rate for Payer: Blue Shield of California Commercial |
$883.89
|
| Rate for Payer: Blue Shield of California EPN |
$707.11
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$941.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,231.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,231.65
|
| Rate for Payer: Dignity Health Senior |
$1,231.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$927.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$896.93
|
| Rate for Payer: Heritage Provider Network Senior |
$896.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$583.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$691.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,014.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,014.30
|
| Rate for Payer: Multiplan Commercial |
$1,086.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$523.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$479.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,231.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,231.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,231.65
|
|
|
HC FACIAL BONES COMPLETE
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
909001101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$60.39 |
| Max. Negotiated Rate |
$814.50 |
| Rate for Payer: Adventist Health Commercial |
$217.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$580.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$746.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.59
|
| Rate for Payer: Blue Shield of California Commercial |
$166.80
|
| Rate for Payer: Blue Shield of California EPN |
$134.13
|
| Rate for Payer: Cash Price |
$597.30
|
| Rate for Payer: Cash Price |
$597.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$705.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$705.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$672.23
|
| Rate for Payer: Heritage Provider Network Senior |
$672.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$518.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$814.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| 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 |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC FACIAL BONES COMPLETE
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
909001101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$196.57 |
| Max. Negotiated Rate |
$814.50 |
| Rate for Payer: Adventist Health Commercial |
$217.20
|
| Rate for Payer: Cash Price |
$597.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$735.22
|
| Rate for Payer: Heritage Provider Network Senior |
$735.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.50
|
| Rate for Payer: Multiplan Commercial |
$814.50
|
|
|
HC FACIAL BONES LIMITED
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
909001102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.09 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$322.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$414.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.71
|
| Rate for Payer: Blue Shield of California Commercial |
$131.04
|
| Rate for Payer: Blue Shield of California EPN |
$105.38
|
| Rate for Payer: Cash Price |
$332.20
|
| Rate for Payer: Cash Price |
$332.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$392.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$392.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$373.88
|
| Rate for Payer: Heritage Provider Network Senior |
$373.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$288.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$453.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| 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 |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC FACIAL BONES LIMITED
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
909001102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.32 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Cash Price |
$332.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.91
|
| Rate for Payer: Heritage Provider Network Senior |
$408.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Multiplan Commercial |
$453.00
|
|
|
HC FACTOR II (2) ASSAY
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
900910075
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.98 |
| Max. Negotiated Rate |
$395.25 |
| Rate for Payer: Adventist Health Commercial |
$105.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$281.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$362.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.56
|
| Rate for Payer: Blue Shield of California Commercial |
$104.49
|
| Rate for Payer: Blue Shield of California EPN |
$83.81
|
| Rate for Payer: Cash Price |
$289.85
|
| Rate for Payer: Cash Price |
$289.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$342.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.28
|
| Rate for Payer: Dignity Health Senior |
$12.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.21
|
| Rate for Payer: Heritage Provider Network Senior |
$326.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$251.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.35
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.98
|
| Rate for Payer: TriValley Medical Group Senior |
$12.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Vantage Medical Group Senior |
$12.98
|
|
|
HC FACTOR II (2) ASSAY
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
900910075
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$95.39 |
| Max. Negotiated Rate |
$395.25 |
| Rate for Payer: Adventist Health Commercial |
$105.40
|
| Rate for Payer: Cash Price |
$289.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$356.78
|
| Rate for Payer: Heritage Provider Network Senior |
$356.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.75
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
|
