|
HC DNA AB DBL STRANDED
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
900913520
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$130.46 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$132.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.46
|
| Rate for Payer: Blue Shield of California Commercial |
$110.59
|
| Rate for Payer: Blue Shield of California Commercial |
$110.59
|
| Rate for Payer: Blue Shield of California EPN |
$88.70
|
| Rate for Payer: Blue Shield of California EPN |
$88.70
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$139.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.26
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.28
|
| Rate for Payer: Heritage Provider Network Senior |
$132.47
|
| Rate for Payer: Heritage Provider Network Senior |
$22.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$102.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.41
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.74
|
| Rate for Payer: TriValley Medical Group Senior |
$13.74
|
| Rate for Payer: TriValley Medical Group Senior |
$13.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Vantage Medical Group Senior |
$13.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13.74
|
|
|
HC DNA AB DBL STRANDED
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
900913520
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$160.50 |
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.82
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.88
|
| Rate for Payer: Heritage Provider Network Senior |
$144.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.50
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
|
|
HC DOPPLER
|
Facility
|
IP
|
$1,794.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
906601558
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$324.71 |
| Max. Negotiated Rate |
$1,345.50 |
| Rate for Payer: Adventist Health Commercial |
$358.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,155.34
|
| Rate for Payer: Cash Price |
$807.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,214.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,214.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$324.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.50
|
| Rate for Payer: Multiplan Commercial |
$1,345.50
|
|
|
HC DOPPLER
|
Facility
|
OP
|
$1,794.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
906601558
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$1,345.50 |
| Rate for Payer: Adventist Health Commercial |
$358.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,108.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$897.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1,116.58
|
| Rate for Payer: Blue Shield of California EPN |
$897.91
|
| Rate for Payer: Cash Price |
$807.30
|
| Rate for Payer: Cash Price |
$807.30
|
| Rate for Payer: Cash Price |
$807.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,166.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,058.46
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,110.49
|
| Rate for Payer: Heritage Provider Network Senior |
$1,110.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$855.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$324.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,345.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$337.57
|
| Rate for Payer: TriValley Medical Group Senior |
$306.88
|
| 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 |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC DRAIN ABSCESS CYST HEM VISTIB
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
900501236
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.08 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$491.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$378.10
|
| Rate for Payer: Blue Shield of California EPN |
$300.89
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$517.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$538.89
|
| Rate for Payer: Heritage Provider Network Senior |
$538.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$379.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$477.60
|
| Rate for Payer: TriValley Medical Group Senior |
$477.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC DRAIN ABSCESS CYST HEM VISTIB
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
900501236
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.08 |
| Max. Negotiated Rate |
$597.00 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$512.62
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$538.89
|
| Rate for Payer: Heritage Provider Network Senior |
$538.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.00
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
|
|
HC DRAIN ABSCESS/HEMATOMA,NASAL
|
Facility
|
OP
|
$754.00
|
|
|
Service Code
|
CPT 30020
|
| Hospital Charge Code |
900501594
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.47 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$150.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$465.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$358.15
|
| Rate for Payer: Blue Shield of California EPN |
$285.01
|
| Rate for Payer: Cash Price |
$339.30
|
| Rate for Payer: Cash Price |
$339.30
|
| Rate for Payer: Cash Price |
$339.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$490.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$693.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$510.46
|
| Rate for Payer: Heritage Provider Network Senior |
$510.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$359.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$797.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$565.50
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$452.40
|
| Rate for Payer: TriValley Medical Group Senior |
$452.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC DRAIN ABSCESS/HEMATOMA,NASAL
|
Facility
|
IP
|
$754.00
|
|
|
Service Code
|
CPT 30020
|
| Hospital Charge Code |
900501594
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.47 |
| Max. Negotiated Rate |
$565.50 |
| Rate for Payer: Adventist Health Commercial |
$150.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$485.58
|
| Rate for Payer: Cash Price |
$339.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$510.46
|
| Rate for Payer: Heritage Provider Network Senior |
$510.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.50
|
| Rate for Payer: Multiplan Commercial |
$565.50
|
|
|
HC DRAIN ABSCESS PALATE UVULA
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
CPT 42000
|
| Hospital Charge Code |
900501466
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.30 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$458.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$352.45
|
| Rate for Payer: Blue Shield of California EPN |
$280.48
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$482.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$304.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.33
|
| Rate for Payer: Heritage Provider Network Senior |
$502.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$353.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$350.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$556.50
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$445.20
|
| Rate for Payer: TriValley Medical Group Senior |
$445.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC DRAIN ABSCESS PALATE UVULA
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
CPT 42000
|
| Hospital Charge Code |
900501466
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.30 |
| Max. Negotiated Rate |
$556.50 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$477.85
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.33
|
| Rate for Payer: Heritage Provider Network Senior |
$502.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$556.50
|
|
|
HC DRAINAGE OF EYE
|
Facility
|
OP
|
$9,492.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
900501746
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,718.05 |
| Max. Negotiated Rate |
$7,119.00 |
| Rate for Payer: Adventist Health Commercial |
$1,898.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,866.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,508.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,587.98
|
| Rate for Payer: Cash Price |
$4,271.40
|
| Rate for Payer: Cash Price |
$4,271.40
|
| Rate for Payer: Cash Price |
$4,271.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,169.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,169.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,968.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,426.08
|
| Rate for Payer: Heritage Provider Network Senior |
$6,426.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,527.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,718.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,413.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,373.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$7,119.00
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,695.20
|
| Rate for Payer: TriValley Medical Group Senior |
$5,695.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
HC DRAINAGE OF EYE
|
Facility
|
IP
|
$9,492.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
900501746
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,718.05 |
| Max. Negotiated Rate |
$7,119.00 |
| Rate for Payer: Adventist Health Commercial |
$1,898.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,112.85
|
| Rate for Payer: Cash Price |
$4,271.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,426.08
|
| Rate for Payer: Heritage Provider Network Senior |
$6,426.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,718.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,373.00
|
| Rate for Payer: Multiplan Commercial |
$7,119.00
|
|
|
HC DRAINAGE OF SALIVARY GLAND
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
CPT 42320
|
| Hospital Charge Code |
900501363
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$133.03 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$147.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$454.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$349.12
|
| Rate for Payer: Blue Shield of California EPN |
$277.83
|
| Rate for Payer: Cash Price |
$330.75
|
| Rate for Payer: Cash Price |
$330.75
|
| Rate for Payer: Cash Price |
$330.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$477.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$693.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$497.60
|
| Rate for Payer: Heritage Provider Network Senior |
$497.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$350.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$797.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$551.25
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$441.00
|
| Rate for Payer: TriValley Medical Group Senior |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC DRAINAGE OF SALIVARY GLAND
|
Facility
|
IP
|
$735.00
|
|
|
Service Code
|
CPT 42320
|
| Hospital Charge Code |
900501363
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$133.03 |
| Max. Negotiated Rate |
$551.25 |
| Rate for Payer: Adventist Health Commercial |
$147.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$473.34
|
| Rate for Payer: Cash Price |
$330.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$497.60
|
| Rate for Payer: Heritage Provider Network Senior |
$497.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.75
|
| Rate for Payer: Multiplan Commercial |
$551.25
|
|
|
HC DRAINAGE/ SCROTAL WALL ABSCESS
|
Facility
|
OP
|
$4,718.00
|
|
|
Service Code
|
CPT 55100
|
| Hospital Charge Code |
900501614
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$853.96 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$943.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,915.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,241.05
|
| Rate for Payer: Blue Shield of California EPN |
$1,783.40
|
| Rate for Payer: Cash Price |
$2,123.10
|
| Rate for Payer: Cash Price |
$2,123.10
|
| Rate for Payer: Cash Price |
$2,123.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,066.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,194.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3,194.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,250.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$853.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,179.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$3,538.50
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,830.80
|
| Rate for Payer: TriValley Medical Group Senior |
$2,830.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC DRAINAGE/ SCROTAL WALL ABSCESS
|
Facility
|
IP
|
$4,718.00
|
|
|
Service Code
|
CPT 55100
|
| Hospital Charge Code |
900501614
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$853.96 |
| Max. Negotiated Rate |
$3,538.50 |
| Rate for Payer: Adventist Health Commercial |
$943.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,038.39
|
| Rate for Payer: Cash Price |
$2,123.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,194.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3,194.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$853.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,179.50
|
| Rate for Payer: Multiplan Commercial |
$3,538.50
|
|
|
HC DRAIN CATH PLCMT HEMATOMA/SEROMA/CYST
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT 10030
|
| Hospital Charge Code |
909020024
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$148.42 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$506.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| 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 |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$533.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$507.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,120.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,730.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,001.86
|
| Rate for Payer: TriValley Medical Group Senior |
$1,001.86
|
| 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 |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC DRAIN CATH PLCMT HEMATOMA/SEROMA/CYST
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
CPT 10030
|
| Hospital Charge Code |
909020024
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$148.42 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$528.08
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$555.14
|
| Rate for Payer: Heritage Provider Network Senior |
$555.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
|
|
HC DRAIN EXT EAR ABSC SIMPLE
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
900501184
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.55 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$411.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$316.35
|
| Rate for Payer: Blue Shield of California EPN |
$251.75
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$432.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$450.88
|
| Rate for Payer: Heritage Provider Network Senior |
$450.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$317.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$499.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$399.60
|
| Rate for Payer: TriValley Medical Group Senior |
$399.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC DRAIN EXT EAR ABSC SIMPLE
|
Facility
|
IP
|
$666.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
900501184
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.55 |
| Max. Negotiated Rate |
$499.50 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$428.90
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$450.88
|
| Rate for Payer: Heritage Provider Network Senior |
$450.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.50
|
| Rate for Payer: Multiplan Commercial |
$499.50
|
|
|
HC DRAIN FINGER ABSCESS COMPL
|
Facility
|
OP
|
$2,314.00
|
|
|
Service Code
|
CPT 26011
|
| Hospital Charge Code |
900501073
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$418.83 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$462.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,430.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,099.15
|
| Rate for Payer: Blue Shield of California EPN |
$874.69
|
| Rate for Payer: Cash Price |
$1,041.30
|
| Rate for Payer: Cash Price |
$1,041.30
|
| Rate for Payer: Cash Price |
$1,041.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,504.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,566.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,566.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,103.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$418.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$1,735.50
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,388.40
|
| Rate for Payer: TriValley Medical Group Senior |
$1,388.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC DRAIN FINGER ABSCESS COMPL
|
Facility
|
IP
|
$2,314.00
|
|
|
Service Code
|
CPT 26011
|
| Hospital Charge Code |
900501073
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$418.83 |
| Max. Negotiated Rate |
$1,735.50 |
| Rate for Payer: Adventist Health Commercial |
$462.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,490.22
|
| Rate for Payer: Cash Price |
$1,041.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,566.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,566.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$418.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.50
|
| Rate for Payer: Multiplan Commercial |
$1,735.50
|
|
|
HC DRAIN FINGER ABSCESS, SIMPLE
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
900501461
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$423.33
|
| 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 |
$325.38
|
| Rate for Payer: Blue Shield of California EPN |
$258.93
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$445.25
|
| 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 |
$463.75
|
| Rate for Payer: Heritage Provider Network Senior |
$463.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$326.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$123.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$513.75
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$411.00
|
| Rate for Payer: TriValley Medical Group Senior |
$411.00
|
| 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 DRAIN FINGER ABSCESS, SIMPLE
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
900501461
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$513.75 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$441.14
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.75
|
| Rate for Payer: Heritage Provider Network Senior |
$463.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$123.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.25
|
| Rate for Payer: Multiplan Commercial |
$513.75
|
|
|
HC DRAIN JP
|
Facility
|
OP
|
$35.09
|
|
| Hospital Charge Code |
909020083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$29.83 |
| Rate for Payer: Adventist Health Commercial |
$7.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.55
|
| Rate for Payer: Blue Shield of California Commercial |
$21.40
|
| Rate for Payer: Blue Shield of California EPN |
$17.12
|
| Rate for Payer: Cash Price |
$15.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.72
|
| Rate for Payer: Heritage Provider Network Senior |
$21.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.56
|
| Rate for Payer: Multiplan Commercial |
$26.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.83
|
| Rate for Payer: Vantage Medical Group Senior |
$29.83
|
|
