|
HC I & D ABSCESS SIMPLE
|
Facility
|
IP
|
$787.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
900501000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.45 |
| Max. Negotiated Rate |
$590.25 |
| Rate for Payer: Adventist Health Commercial |
$157.40
|
| Rate for Payer: Cash Price |
$432.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$532.80
|
| Rate for Payer: Heritage Provider Network Senior |
$532.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.75
|
| Rate for Payer: Multiplan Commercial |
$590.25
|
|
|
HC I & D ABSCESS,THROAT INTRAORAL
|
Facility
|
IP
|
$5,338.00
|
|
|
Service Code
|
CPT 42720
|
| Hospital Charge Code |
900501607
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$966.18 |
| Max. Negotiated Rate |
$4,003.50 |
| Rate for Payer: Adventist Health Commercial |
$1,067.60
|
| Rate for Payer: Cash Price |
$2,935.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,613.83
|
| Rate for Payer: Heritage Provider Network Senior |
$3,613.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$966.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,334.50
|
| Rate for Payer: Multiplan Commercial |
$4,003.50
|
|
|
HC I & D ABSCESS,THROAT INTRAORAL
|
Facility
|
OP
|
$5,338.00
|
|
|
Service Code
|
CPT 42720
|
| Hospital Charge Code |
900501607
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,067.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,667.21
|
| 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 |
$2,935.90
|
| Rate for Payer: Cash Price |
$2,935.90
|
| Rate for Payer: Cash Price |
$2,935.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,469.70
|
| 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 |
$3,613.83
|
| Rate for Payer: Heritage Provider Network Senior |
$3,613.83
|
| 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 |
$2,546.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$966.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,738.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,334.50
|
| 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 |
$4,003.50
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,920.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,767.41
|
| 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 I & D ARM BURSA
|
Facility
|
IP
|
$5,169.00
|
|
|
Service Code
|
CPT 23931
|
| Hospital Charge Code |
900501660
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$935.59 |
| Max. Negotiated Rate |
$3,876.75 |
| Rate for Payer: Adventist Health Commercial |
$1,033.80
|
| Rate for Payer: Cash Price |
$2,842.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,499.41
|
| Rate for Payer: Heritage Provider Network Senior |
$3,499.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$935.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,292.25
|
| Rate for Payer: Multiplan Commercial |
$3,876.75
|
|
|
HC I & D ARM BURSA
|
Facility
|
OP
|
$5,169.00
|
|
|
Service Code
|
CPT 23931
|
| Hospital Charge Code |
900501660
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,033.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,551.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$2,842.95
|
| Rate for Payer: Cash Price |
$2,842.95
|
| Rate for Payer: Cash Price |
$2,842.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,359.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,499.41
|
| Rate for Payer: Heritage Provider Network Senior |
$3,499.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,465.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$935.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,292.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$3,876.75
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,859.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,711.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC I&D BARTHOLIN ABSC
|
Facility
|
IP
|
$842.00
|
|
|
Service Code
|
CPT 56420
|
| Hospital Charge Code |
900501169
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.40 |
| Max. Negotiated Rate |
$631.50 |
| Rate for Payer: Adventist Health Commercial |
$168.40
|
| Rate for Payer: Cash Price |
$463.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$570.03
|
| Rate for Payer: Heritage Provider Network Senior |
$570.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.50
|
| Rate for Payer: Multiplan Commercial |
$631.50
|
|
|
HC I&D BARTHOLIN ABSC
|
Facility
|
OP
|
$842.00
|
|
|
Service Code
|
CPT 56420
|
| Hospital Charge Code |
900501169
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$168.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$578.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$463.10
|
| Rate for Payer: Cash Price |
$463.10
|
| Rate for Payer: Cash Price |
$463.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$547.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$383.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.17
|
| Rate for Payer: Dignity Health Senior |
$255.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$255.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$570.03
|
| Rate for Payer: Heritage Provider Network Senior |
$570.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$255.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$401.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$322.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$322.07
|
| Rate for Payer: Multiplan Commercial |
$631.50
|
| Rate for Payer: Multiplan WC |
$407.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$302.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$278.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Vantage Medical Group Senior |
$255.61
|
|
|
HC I & D COMPL POST-OP WND INF
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
900501007
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Cash Price |
$590.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$727.10
|
| Rate for Payer: Heritage Provider Network Senior |
$727.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
|
|
HC I & D COMPL POST-OP WND INF
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
900501007
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$737.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,636.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$590.70
|
| Rate for Payer: Cash Price |
$590.70
|
| Rate for Payer: Cash Price |
$590.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$698.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,000.17
|
| Rate for Payer: Dignity Health Senior |
$3,636.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,636.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$727.10
|
| Rate for Payer: Heritage Provider Network Senior |
$727.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,636.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$512.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,182.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,582.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,582.02
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$386.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$355.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3,636.52
|
|
|
HC I & D DEEP ABSCESS NECK/THORAX
|
Facility
|
OP
|
$5,007.00
|
|
|
Service Code
|
CPT 21501
|
| Hospital Charge Code |
900501670
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,001.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,439.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,636.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$2,753.85
|
| Rate for Payer: Cash Price |
$2,753.85
|
| Rate for Payer: Cash Price |
$2,753.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,254.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,000.17
|
| Rate for Payer: Dignity Health Senior |
$3,636.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,636.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,389.74
|
| Rate for Payer: Heritage Provider Network Senior |
$3,389.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,636.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,388.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$906.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,182.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,251.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,582.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,582.02
|
| Rate for Payer: Multiplan Commercial |
$3,755.25
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,801.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,657.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3,636.52
|
|
|
HC I & D DEEP ABSCESS NECK/THORAX
|
Facility
|
IP
|
$5,007.00
|
|
|
Service Code
|
CPT 21501
|
| Hospital Charge Code |
900501670
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$906.27 |
| Max. Negotiated Rate |
$3,755.25 |
| Rate for Payer: Adventist Health Commercial |
$1,001.40
|
| Rate for Payer: Cash Price |
$2,753.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,389.74
|
| Rate for Payer: Heritage Provider Network Senior |
$3,389.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$906.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,251.75
|
| Rate for Payer: Multiplan Commercial |
$3,755.25
|
|
|
HC I&D DENTOALVEOLAR ABSC/HEMAT
|
Facility
|
OP
|
$646.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
900501150
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$443.80
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$355.30
|
| Rate for Payer: Cash Price |
$355.30
|
| Rate for Payer: Cash Price |
$355.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$419.90
|
| 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 |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$437.34
|
| Rate for Payer: Heritage Provider Network Senior |
$437.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$308.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.50
|
| 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 |
$484.50
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$232.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$213.89
|
| 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 I&D DENTOALVEOLAR ABSC/HEMAT
|
Facility
|
IP
|
$646.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
900501150
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.93 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Cash Price |
$355.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$437.34
|
| Rate for Payer: Heritage Provider Network Senior |
$437.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.50
|
| Rate for Payer: Multiplan Commercial |
$484.50
|
|
|
HC IDENTIFY SENTINEL NODE
|
Facility
|
OP
|
$802.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
909301345
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$160.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$550.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$441.10
|
| Rate for Payer: Cash Price |
$441.10
|
| Rate for Payer: Cash Price |
$441.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$521.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Senior |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$496.44
|
| Rate for Payer: Heritage Provider Network Senior |
$628.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$970.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.32
|
| Rate for Payer: Multiplan Commercial |
$601.50
|
| Rate for Payer: Multiplan WC |
$813.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.63
|
| Rate for Payer: TriValley Medical Group Senior |
$561.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC IDENTIFY SENTINEL NODE
|
Facility
|
IP
|
$802.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
909301345
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.16 |
| Max. Negotiated Rate |
$601.50 |
| Rate for Payer: Adventist Health Commercial |
$160.40
|
| Rate for Payer: Cash Price |
$441.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$542.95
|
| Rate for Payer: Heritage Provider Network Senior |
$542.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.50
|
| Rate for Payer: Multiplan Commercial |
$601.50
|
|
|
HC IDENT OF ARTHROPOD
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 87168
|
| Hospital Charge Code |
900912431
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.86 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Cash Price |
$90.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.70
|
| Rate for Payer: Heritage Provider Network Senior |
$111.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.25
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
|
|
HC IDENT OF ARTHROPOD
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 87168
|
| Hospital Charge Code |
900912431
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$88.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$113.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.97
|
| Rate for Payer: Blue Shield of California Commercial |
$34.33
|
| Rate for Payer: Blue Shield of California EPN |
$27.54
|
| Rate for Payer: Cash Price |
$90.75
|
| Rate for Payer: Cash Price |
$90.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$107.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.14
|
| Rate for Payer: Heritage Provider Network Senior |
$102.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$78.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.38
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Senior |
$4.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC IDENT OF PARASITES
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
900911657
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.86 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Cash Price |
$90.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.70
|
| Rate for Payer: Heritage Provider Network Senior |
$111.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.25
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
|
|
HC IDENT OF PARASITES
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
900911657
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$88.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$113.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.97
|
| Rate for Payer: Blue Shield of California Commercial |
$34.33
|
| Rate for Payer: Blue Shield of California EPN |
$27.54
|
| Rate for Payer: Cash Price |
$90.75
|
| Rate for Payer: Cash Price |
$90.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$107.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: Dignity Health Senior |
$4.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.14
|
| Rate for Payer: Heritage Provider Network Senior |
$102.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$78.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.31
|
| Rate for Payer: TriValley Medical Group Senior |
$4.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Senior |
$4.31
|
|
|
HC I & D EXTERNAL AUDITORY CANAL
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
900501255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$457.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$432.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Senior |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$893.98
|
| 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) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$317.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,028.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,126.41
|
| Rate for Payer: Multiplan Commercial |
$499.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$239.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC I & D EXTERNAL AUDITORY CANAL
|
Facility
|
IP
|
$666.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
900501255
|
|
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: Cash Price |
$366.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$450.88
|
| Rate for Payer: Heritage Provider Network Senior |
$450.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.50
|
| Rate for Payer: Multiplan Commercial |
$499.50
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
IP
|
$4,824.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$873.14 |
| Max. Negotiated Rate |
$3,618.00 |
| Rate for Payer: Adventist Health Commercial |
$964.80
|
| Rate for Payer: Cash Price |
$2,653.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,265.85
|
| Rate for Payer: Heritage Provider Network Senior |
$3,265.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$873.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,206.00
|
| Rate for Payer: Multiplan Commercial |
$3,618.00
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
OP
|
$4,824.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$964.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,314.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$2,653.20
|
| Rate for Payer: Cash Price |
$2,653.20
|
| Rate for Payer: Cash Price |
$2,653.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,135.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,986.06
|
| Rate for Payer: Heritage Provider Network Senior |
$2,532.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,911.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$873.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,206.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$3,618.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,264.55
|
| Rate for Payer: TriValley Medical Group Senior |
$2,264.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
IP
|
$4,824.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$873.14 |
| Max. Negotiated Rate |
$3,618.00 |
| Rate for Payer: Adventist Health Commercial |
$964.80
|
| Rate for Payer: Cash Price |
$2,653.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,265.85
|
| Rate for Payer: Heritage Provider Network Senior |
$3,265.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$873.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,206.00
|
| Rate for Payer: Multiplan Commercial |
$3,618.00
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
OP
|
$4,824.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$964.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,314.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$2,653.20
|
| Rate for Payer: Cash Price |
$2,653.20
|
| Rate for Payer: Cash Price |
$2,653.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,135.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,265.85
|
| Rate for Payer: Heritage Provider Network Senior |
$3,265.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,301.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$873.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,206.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$3,618.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,735.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,597.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
