|
HC IMPL PRIMATRIX AG 4CM X 4CM MESH
|
Facility
OP
|
$166.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101522
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$141.10 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$95.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$141.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$91.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$124.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.80
|
| Rate for Payer: Blue Shield of California Commercial |
$103.09
|
| Rate for Payer: Blue Shield of California EPN |
$97.44
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.10
|
| Rate for Payer: Dignity Health Senior |
$141.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.86
|
| Rate for Payer: Heritage Provider Network Senior |
$76.86
|
| Rate for Payer: IEHP Medi-Cal |
$66.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.50
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$60.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.10
|
| Rate for Payer: Vantage Medical Group Senior |
$141.10
|
|
|
HC IMPL PRIMATRIX AG 6CM X 6CM FENESTRATED
|
Facility
IP
|
$133.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101523
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$91.37
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.04
|
| Rate for Payer: Heritage Provider Network Senior |
$90.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.25
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$48.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.44
|
|
|
HC IMPL PRIMATRIX AG 6CM X 6CM FENESTRATED
|
Facility
OP
|
$133.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101523
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$113.05 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$95.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$91.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$113.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$73.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$99.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.80
|
| Rate for Payer: Blue Shield of California Commercial |
$82.59
|
| Rate for Payer: Blue Shield of California EPN |
$78.07
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.05
|
| Rate for Payer: Dignity Health Senior |
$113.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.58
|
| Rate for Payer: Heritage Provider Network Senior |
$61.58
|
| Rate for Payer: IEHP Medi-Cal |
$66.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$64.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.25
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$48.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.05
|
| Rate for Payer: Vantage Medical Group Senior |
$113.05
|
|
|
HC IMRT TREATMENT DELIVERY COMPLEX
|
Facility
OP
|
$1,913.00
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
909177386
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$346.25 |
| Max. Negotiated Rate |
$3,990.50 |
| Rate for Payer: Adventist Health Commercial |
$382.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$894.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,314.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,103.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$809.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$735.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,990.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,187.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,122.93
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,243.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$809.04
|
| Rate for Payer: Dignity Health Senior |
$735.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,243.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$735.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,184.15
|
| Rate for Payer: Heritage Provider Network Senior |
$1,184.15
|
| Rate for Payer: Humana Medicare |
$735.49
|
| Rate for Payer: IEHP Medicare Advantage |
$735.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,397.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$867.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$478.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$926.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$926.72
|
| Rate for Payer: Multiplan Commercial |
$1,434.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$625.17
|
| Rate for Payer: TriValley Medical Group Senior |
$625.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$809.04
|
| Rate for Payer: Vantage Medical Group Senior |
$735.49
|
|
|
HC IMRT TREATMENT DELIVERY COMPLEX
|
Facility
IP
|
$1,913.00
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
909177386
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$346.25 |
| Max. Negotiated Rate |
$1,434.75 |
| Rate for Payer: Adventist Health Commercial |
$382.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,314.23
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,295.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,295.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$478.25
|
| Rate for Payer: Multiplan Commercial |
$1,434.75
|
|
|
HC IMRT TREATMENT DELIVERY SIMPLE
|
Facility
OP
|
$1,913.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
909177385
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$346.25 |
| Max. Negotiated Rate |
$3,324.77 |
| Rate for Payer: Adventist Health Commercial |
$382.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$893.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,314.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,103.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$809.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$735.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,324.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1,187.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,122.93
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,243.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$809.04
|
| Rate for Payer: Dignity Health Senior |
$735.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,243.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$735.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,184.15
|
| Rate for Payer: Heritage Provider Network Senior |
$1,184.15
|
| Rate for Payer: Humana Medicare |
$735.49
|
| Rate for Payer: IEHP Medicare Advantage |
$735.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,397.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$867.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$478.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$926.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$926.72
|
| Rate for Payer: Multiplan Commercial |
$1,434.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$625.17
|
| Rate for Payer: TriValley Medical Group Senior |
$625.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$809.04
|
| Rate for Payer: Vantage Medical Group Senior |
$735.49
|
|
|
HC IMRT TREATMENT DELIVERY SIMPLE
|
Facility
IP
|
$1,913.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
909177385
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$346.25 |
| Max. Negotiated Rate |
$1,434.75 |
| Rate for Payer: Adventist Health Commercial |
$382.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,314.23
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,295.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,295.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$478.25
|
| Rate for Payer: Multiplan Commercial |
$1,434.75
|
|
|
HC IN111 PENTETRTID/OCTRE/LT 6MCI
|
Facility
OP
|
$19,095.00
|
|
|
Service Code
|
CPT A9572
|
| Hospital Charge Code |
909301570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,456.20 |
| Max. Negotiated Rate |
$19,250.08 |
| Rate for Payer: Adventist Health Commercial |
$3,819.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16,230.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10,502.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14,321.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19,250.08
|
| Rate for Payer: Blue Shield of California Commercial |
$11,858.00
|
| Rate for Payer: Blue Shield of California EPN |
$11,208.76
|
| Rate for Payer: Cash Price |
$8,592.75
|
| Rate for Payer: Cash Price |
$8,592.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,783.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,230.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,230.75
|
| Rate for Payer: Dignity Health Senior |
$16,230.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,220.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,840.98
|
| Rate for Payer: Heritage Provider Network Senior |
$8,840.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,203.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,456.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,773.75
|
| Rate for Payer: Multiplan Commercial |
$14,321.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,962.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,379.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,230.75
|
| Rate for Payer: Vantage Medical Group Senior |
$16,230.75
|
|
|
HC IN111 PENTETRTID/OCTRE/LT 6MCI
|
Facility
IP
|
$19,095.00
|
|
|
Service Code
|
CPT A9572
|
| Hospital Charge Code |
909301570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,456.20 |
| Max. Negotiated Rate |
$14,321.25 |
| Rate for Payer: Adventist Health Commercial |
$3,819.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,118.26
|
| Rate for Payer: Cash Price |
$8,592.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,783.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,311.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,927.32
|
| Rate for Payer: Heritage Provider Network Senior |
$12,927.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,456.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,773.75
|
| Rate for Payer: Multiplan Commercial |
$14,321.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,962.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,379.64
|
|
|
HC IN111 PROSTASCINT UP TO 10 MCI
|
Facility
OP
|
$8,469.00
|
|
|
Service Code
|
CPT A9507
|
| Hospital Charge Code |
909301255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,532.89 |
| Max. Negotiated Rate |
$7,198.65 |
| Rate for Payer: Adventist Health Commercial |
$1,693.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,198.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,657.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,351.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,109.47
|
| Rate for Payer: Blue Shield of California Commercial |
$5,259.25
|
| Rate for Payer: Blue Shield of California EPN |
$4,971.30
|
| Rate for Payer: Cash Price |
$3,811.05
|
| Rate for Payer: Cash Price |
$3,811.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,895.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,198.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,198.65
|
| Rate for Payer: Dignity Health Senior |
$7,198.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,420.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,921.15
|
| Rate for Payer: Heritage Provider Network Senior |
$3,921.15
|
| Rate for Payer: IEHP Medi-Cal |
$3,513.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,082.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,532.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,117.25
|
| Rate for Payer: Multiplan Commercial |
$6,351.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,087.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,829.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,198.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7,198.65
|
|
|
HC IN111 PROSTASCINT UP TO 10 MCI
|
Facility
IP
|
$8,469.00
|
|
|
Service Code
|
CPT A9507
|
| Hospital Charge Code |
909301255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,532.89 |
| Max. Negotiated Rate |
$6,351.75 |
| Rate for Payer: Adventist Health Commercial |
$1,693.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,818.20
|
| Rate for Payer: Cash Price |
$3,811.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,895.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,573.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,733.51
|
| Rate for Payer: Heritage Provider Network Senior |
$5,733.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,532.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,117.25
|
| Rate for Payer: Multiplan Commercial |
$6,351.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,087.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,829.49
|
|
|
HC IN111 ZEVALIN UP TO 5 MCI
|
Facility
IP
|
$2,750.00
|
|
|
Service Code
|
CPT A9542
|
| Hospital Charge Code |
909301342
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$497.75 |
| Max. Negotiated Rate |
$2,062.50 |
| Rate for Payer: Adventist Health Commercial |
$550.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,889.25
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,861.75
|
| Rate for Payer: Heritage Provider Network Senior |
$1,861.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$687.50
|
| Rate for Payer: Multiplan Commercial |
$2,062.50
|
|
|
HC IN111 ZEVALIN UP TO 5 MCI
|
Facility
OP
|
$2,750.00
|
|
|
Service Code
|
CPT A9542
|
| Hospital Charge Code |
909301342
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$497.75 |
| Max. Negotiated Rate |
$5,480.54 |
| Rate for Payer: Adventist Health Commercial |
$550.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,337.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,512.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,062.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,480.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,707.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,614.25
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,787.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,337.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,337.50
|
| Rate for Payer: Dignity Health Senior |
$2,337.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,787.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,702.25
|
| Rate for Payer: Heritage Provider Network Senior |
$1,702.25
|
| Rate for Payer: IEHP Medi-Cal |
$5,445.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,325.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$687.50
|
| Rate for Payer: Multiplan Commercial |
$2,062.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,337.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,337.50
|
|
|
HC INCISE/DRAIN TEAR GLAND
|
Facility
IP
|
$683.00
|
|
|
Service Code
|
CPT 68400
|
| Hospital Charge Code |
900501642
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.62 |
| Max. Negotiated Rate |
$512.25 |
| Rate for Payer: Adventist Health Commercial |
$136.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$469.22
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$462.39
|
| Rate for Payer: Heritage Provider Network Senior |
$462.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.75
|
| Rate for Payer: Multiplan Commercial |
$512.25
|
|
|
HC INCISE/DRAIN TEAR GLAND
|
Facility
OP
|
$683.00
|
|
|
Service Code
|
CPT 68400
|
| Hospital Charge Code |
900501642
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.62 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$136.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$469.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,897.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,391.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,264.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$443.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,391.47
|
| Rate for Payer: Dignity Health Senior |
$1,264.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$443.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,264.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$462.39
|
| Rate for Payer: Heritage Provider Network Senior |
$462.39
|
| Rate for Payer: Humana Medicare |
$1,264.97
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,264.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$329.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,492.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,593.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,593.86
|
| Rate for Payer: Multiplan Commercial |
$512.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$228.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,391.47
|
| Rate for Payer: Vantage Medical Group Senior |
$1,264.97
|
|
|
HC INCISIONAL BX SKIN SINGLE LSN
|
Facility
IP
|
$868.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
900511106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$157.11 |
| Max. Negotiated Rate |
$651.00 |
| Rate for Payer: Adventist Health Commercial |
$173.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$596.32
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$587.64
|
| Rate for Payer: Heritage Provider Network Senior |
$587.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.00
|
| Rate for Payer: Multiplan Commercial |
$651.00
|
|
|
HC INCISIONAL BX SKIN SINGLE LSN
|
Facility
OP
|
$868.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
900511106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$157.11 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$173.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$596.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$564.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: Dignity Health Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$537.29
|
| Rate for Payer: Heritage Provider Network Senior |
$965.19
|
| Rate for Payer: Humana Medicare |
$784.71
|
| Rate for Payer: IEHP Medi-Cal |
$211.99
|
| Rate for Payer: IEHP Medicare Advantage |
$784.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,490.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.73
|
| Rate for Payer: Multiplan Commercial |
$651.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$863.18
|
| Rate for Payer: TriValley Medical Group Senior |
$863.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC INCISION DRAIN DEEP RECTAL ABSCESS
|
Facility
OP
|
$5,376.00
|
|
|
Service Code
|
CPT 45020
|
| Hospital Charge Code |
900501241
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,075.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,693.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,508.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,419.20
|
| Rate for Payer: Cash Price |
$2,419.20
|
| Rate for Payer: Cash Price |
$2,419.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,494.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,858.96
|
| Rate for Payer: Dignity Health Senior |
$3,508.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,508.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,639.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3,639.55
|
| Rate for Payer: Humana Medicare |
$3,508.15
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$3,508.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,591.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$973.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,139.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,344.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,420.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,420.27
|
| Rate for Payer: Multiplan Commercial |
$4,032.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,952.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,796.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,508.15
|
|
|
HC INCISION DRAIN DEEP RECTAL ABSCESS
|
Facility
IP
|
$5,376.00
|
|
|
Service Code
|
CPT 45020
|
| Hospital Charge Code |
900501241
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.06 |
| Max. Negotiated Rate |
$4,032.00 |
| Rate for Payer: Adventist Health Commercial |
$1,075.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,693.31
|
| Rate for Payer: Cash Price |
$2,419.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,639.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3,639.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$973.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,344.00
|
| Rate for Payer: Multiplan Commercial |
$4,032.00
|
|
|
HC INCISION/DRAIN FOREARM/WRIST
|
Facility
OP
|
$4,774.00
|
|
|
Service Code
|
CPT 25028
|
| Hospital Charge Code |
900501423
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$864.09 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$954.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,279.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$2,148.30
|
| Rate for Payer: Cash Price |
$2,148.30
|
| Rate for Payer: Cash Price |
$2,148.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,103.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,232.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,232.00
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,301.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$864.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,193.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: Multiplan Commercial |
$3,580.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,733.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,594.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC INCISION/DRAIN FOREARM/WRIST
|
Facility
IP
|
$4,774.00
|
|
|
Service Code
|
CPT 25028
|
| Hospital Charge Code |
900501423
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$864.09 |
| Max. Negotiated Rate |
$3,580.50 |
| Rate for Payer: Adventist Health Commercial |
$954.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,279.74
|
| Rate for Payer: Cash Price |
$2,148.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,232.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,232.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$864.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,193.50
|
| Rate for Payer: Multiplan Commercial |
$3,580.50
|
|
|
HC INCISION/DRAIN PERIRECTAL ABSC
|
Facility
OP
|
$3,735.00
|
|
|
Service Code
|
CPT 45005
|
| Hospital Charge Code |
900501237
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$676.04 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$747.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,565.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,680.75
|
| Rate for Payer: Cash Price |
$1,680.75
|
| Rate for Payer: Cash Price |
$1,680.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,427.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.86
|
| Rate for Payer: Dignity Health Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,474.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,528.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2,528.60
|
| Rate for Payer: Humana Medicare |
$1,474.42
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,474.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,800.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$676.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$933.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,857.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,857.77
|
| Rate for Payer: Multiplan Commercial |
$2,801.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,356.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,247.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC INCISION/DRAIN PERIRECTAL ABSC
|
Facility
IP
|
$3,735.00
|
|
|
Service Code
|
CPT 45005
|
| Hospital Charge Code |
900501237
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$676.04 |
| Max. Negotiated Rate |
$2,801.25 |
| Rate for Payer: Adventist Health Commercial |
$747.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,565.94
|
| Rate for Payer: Cash Price |
$1,680.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,528.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2,528.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$676.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$933.75
|
| Rate for Payer: Multiplan Commercial |
$2,801.25
|
|
|
HC INCISION/DRAIN THIGH/KNEE LESI
|
Facility
OP
|
$4,583.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
909000271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$109.76 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$916.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,148.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$2,062.35
|
| Rate for Payer: Cash Price |
$2,062.35
|
| Rate for Payer: Cash Price |
$2,062.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,978.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: Dignity Health Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,550.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,836.88
|
| Rate for Payer: Heritage Provider Network Senior |
$4,366.82
|
| Rate for Payer: Humana Medicare |
$3,550.26
|
| Rate for Payer: IEHP Medi-Cal |
$109.76
|
| Rate for Payer: IEHP Medicare Advantage |
$3,550.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,745.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$829.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,189.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,145.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,473.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,473.33
|
| Rate for Payer: Multiplan Commercial |
$3,437.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,905.29
|
| Rate for Payer: TriValley Medical Group Senior |
$3,905.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
HC INCISION/DRAIN THIGH/KNEE LESI
|
Facility
IP
|
$4,583.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
909000271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$829.52 |
| Max. Negotiated Rate |
$3,437.25 |
| Rate for Payer: Adventist Health Commercial |
$916.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,148.52
|
| Rate for Payer: Cash Price |
$2,062.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,102.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,102.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$829.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,145.75
|
| Rate for Payer: Multiplan Commercial |
$3,437.25
|
|
